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RC261  .Sa3  The  conquest  of  cane 

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THE  CONQUEST 
OF  CANCER 

A  PLAN  OF  CAMPAIGN 


BEING     AN      ACCOUNT     OF     THE     PRINCIPLES     AND 

PRACTICE    HITHERTO    OF    THE    TREATMENT    OF 

MALIGNANT    GROWTHS     BY      SPECIFIC     OR 

CANCROTOXIC     FERMENTS 


BY 


C.  W.  SALEEBY,  M.  D. 

F.  R.  S.  (Edin.) 

Author  of  "Worry, ''^   "Heredity,''    "Evolution,'"    "Psychology,^* 

"Sociology,''    "Ethics,"   etc. 


NEW  YORK 

FREDERICK  A.  STOKES  COMPANY 

Publishers 


Copyright,  1907, 
By  Frederick  A.  Stokes  Company 


All  Rights  Reserved 
November,  1907 


This  Book  is 
DEDICATED 

TO 

The  Cause  of  Human  Life 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/conquestofcancerOOsale 


PREFACE 

Believing,  as  I  do,  with  Dr.  Beard  and  Prof.  Von  Ley- 
den  and  many  others  after  him,  that  the  war  with  cancer 
during  the  past  half-century — which  comprises  prac- 
tically the  whole  of  the  scientific  period  in  medicine — has 
hitherto  been  conducted  on  lines  all  but  unprofitable  and 
irrelevant,  as  the  lamentable  failure  to  obtain  practical  re- 
sults only  too  fully  demonstrates,  I  have  called  this  vol- 
ume "The  Conquest  of  Cancer"  rather  than,  for  instance, 
"The  War  with  Cancer,"  not  because  I  wish  to  maintain 
any  such  monstrously  untenable  thesis  as  that  the  disease 
has  been  actually  conquered,  but  because  I  hold  that  there 
is  abundant  warrant  for  the  belief  that  the  new  mode  of 
attack  indicated  and  initiated  by  Dr.  Beard  gives  us  the 
key  to  the  enemy's  position,  and  that  so  soon  as  this  ad- 
vantage be  pressed  home,  the  conquest  of  cancer  will  be 
an  accomplished  fact.  The  evidence  and  the  arguments 
of  the  succeeding  pages  are  submitted  in  the  belief  that 
they  should  suffice  to  direct  the  attention  of  the  practical 
worker  away  from  modes  of  attack  which  have  hitherto 
proved  wholly  unprofitable,  towards  a  new  mode  which 
commends  itself  on  two  distinct  counts. 

It  commends  itself  becaifee  of  the  favorable  results 
which  have  already  been  recorded,  in  practice,  by  ob- 
servers so  eminent  as  Profs.  Von  Leyden  and  Bier  of  the 
University  of  Berlin,  to  name  only  two  of  the  foremost 
workers  associated  with  the  attack  on  cancer  by  means 


X  PREFACE 

of  specific  cancrotoxic  ferments,  as  I  propose  that  they 
should  be  called.  But  though  he  would  be  hardy  indeed 
who  should  question  to-day  the  actual  achievement  of 
such  results,  and  though  I  have  necessarily  devoted  some 
space  to  them,  the  new  plan  of  campaign  in  the  war  with 
cancer  commends  itself — to  those  who,  however  deeply 
interested,  are  not  themselves  the  subjects  of  cancer — 
far  more  on  rational  and  abstract  grounds.  It  is  based 
upon  the  conception  of  a  radical  chemical  difference 
between  the  malignant  and  the  normal  cell,  upon  the  con- 
ception of  fermentation  as  absolutely  the  most  radical  fact 
of  all  life,  and  upon  the  equally  well-attested  doctrine  of 
the  specific  character  of  ferment  action :  whilst,  on  its 
practical  side,  the  new  inquiry  regards  the  rare  but  in- 
disputable spontaneous  cure  of  the  disease  as  a  capital 
fact  and  no  longer  as  a  mere  surgical  curiosity.  It  may 
be  earnestly  recommended  that  when  next  an  indisputable 
case  of  spontaneous  cure  or  change  in  that  direction  be 
observed,  the  patient  should  no  longer  be  reported  on  at 
long  and  casual  intervals  as  regards  the  merely  local 
condition,  but  that,  if  possible,  he  be  retained  for  the  most 
exhaustive  and  prolonged  study  on  the  lines  of  modern 
clinical  pathology.  Too  much  cannot  be  known  regard- 
ing the  condition  of  the  blood  and  urine  and  metabolism 
generally  of  such  a  patient.  To  the  best  of  my  knowl- 
edge all  such  opportunities — which,  as  I  believe,  will 
prove  priceless — have  hitherto  been  totally  ignored,  sim- 
ply because  the  war  with  cancer  hitherto  has  been  con- 
ducted almost  exclusively  on  surgical  lines,  without 
thought  of  the  matters  which,  directly  attention  is 
directed  to  them,  are  seen  to  be  fundamental. 

Though,  in  the  absence  of  more  authoritative  writers, 
I  have  constituted  myself,  amid  general  censure,  the  sole 


PREFACE  xi 

public  advocate  of  the  pancreatic  ferments  since  March, 
1906,  I  hold  no  brief  for  them;  and  the  fact  that  they 
take  the  most  prominent  place  in  the  succeeding  pages 
may  possibly  be  nothing  more  than  a  historical  accident. 
If,  despite  what  so  many  observers  report  them  to  have 
accomplished,  they  prove  relatively  inefficient  as  com- 
pared with  other  ferments,  known  or  unknown,  tried  or 
untried,  I  shall  certainly  never  waste  another  moment  in 
urging  their  claims.  When  these  came  before  me,  and 
for  some  time  afterwards,  if  not — as  may  be — to-day  also, 
they  far  surpassed  anything  proposed  or  employed  as 
weapons  against  cancer :  if  they  in  their  turn  can  be  sur- 
passed I  shall  as  persistently  urge  the  claims  of  their 
supersessors  as  I  have  hitherto  urged  their  own,  and  if 
any  one  cares  to  say  that  I  have  abandoned  trypsin,  he  is 
heartily  welcome  to  do  so.  If  and  when  its  superiors  be 
obtainable,  by  all  means  let  it  pass  forever  from  the  mem- 
ory of  all  but  the  historian  of  science. 

Whatever  the  ultimate  verdict  on  trypsin,  I  shall  be 
well  content  if  the  following  pages  suffice  to  demonstrate 
that  the  pioneer  work  of  Dr.  Beard  and  his  followers 
points  the  way  to  all  future  work  upon  cancer,  imme- 
diate and  remote ;  if,  in  a  word,  it  be  demonstrated  effect- 
ively that  the  attack  upon  cancer  by  means  of  specific 
ferments  is,  because  it  must  necessarily  be,  not  merely  the 
most  successful  hitherto,  but  the  naturally  appointed  and 
indicated  means  by  which  this  most  accursed  thing  is  to 
be  mastered  by  man. 

In  the  text  I  attempt  to  deal  with  the  relations  between 
cancer  and  surgery,  considered  from  the  point  of  view  of 
actual  practice.  Here,  however,  I  wish  to  comment  upon 
their  scientific  relations.  In  the  pre-scientific  days,  cancer 
was  naturally  a  "surgical  disease,"  and,  later,  the  mag- 


xii  PREFACE 

nificent  achievements  of  Simpson  and  Lister,  which  the 
resistance  of  contemporary  surgeons  could  not  prevent, 
greatly  enlarged  the  scope  of  the  surgery  of  cancer.  The 
disease  is  still  considered  to  be  a  surgical  affection,  and 
its  study  hitherto  has  almost  entirely  been  confined  to  the 
surgeon  and  the  microscopist.  As  regards  practice, 
surgery  as  a  whole  has  a  record  of  the  most  signal  and 
lamentable  failure.  The  fault  may  not  lie  with  the 
surgeons,  or  not  with  them  wholly,  but  the  fact  is  indis- 
putable, as  common  experience  and  the  death-rate  from 
cancer  show.  But  as  regards  the  study  of  the  disease,  it 
has  yet  to  be  recognized  that  the  surgeons  have  failed  no 
less  signally.  During  the  sixty  years  since  the  introduc- 
tion of  chloroform,  millions  of  cases  of  cancer  have  been 
available  for  study  by  the  surgeons,  and  it  is  doubtful 
whether  they  have  added  anything  essential  to  our  knowl- 
edge of  it  except  such  as  is  contained  in  the  dictum  of  Sir 
James  Paget — a  surgeon  who,  like  Lister,  was  so  much 
more  than  a  surgeon — that  a  cancer  is  an  "imitation- 
tissue."  The  surgeon  has  his  invaluable  work  to  do,  but 
his  habit  of  mind — or,  rather,  of  hand — is  not  adapted 
for  the  study  of  cancer.  In  the  report  of  the  Middlesex 
Hospital  upon  the  pancreatic  treatment  (May,  1907) 
there  is  not  even  included  any  account  of  the  urine,  let 
alone  the  blood,  of  the  patients  under  observation.  The 
fact  would  be  incredible  were  the  report  not  available  to 
all.  The  surgeon's  sole  interest  in  cancer,  which  has 
been  too  entirely  relegated  to  him,  lies  in  the  question, 
"Can  I  cut  it  out?"  He  will  study  with  minuteness  the 
channels  in  which  it  spreads,  since  this  bears  upon  opera- 
tion, and  he  favors  the  microscopist,  since  he  hopes — • 
though  often  deceived — that  the  microscope  will  aid  him 
in  diagnosis.     But,  for  choice^  he  prefers  the  diagnostic 


PREFACE  xiii 

incision,  A  case  of  spontaneous  cure — who  should  be 
retained  for  study  at  any  fee  he  cares  to  ask — is  noted 
as  a  curiosity,  but  its  overwhelming  significance  is  ig- 
nored. The  surgeon's  knife  not  being  requisitioned,  he 
turns  elsewhere ;  the  physician  leaves  cancer  to  the  sur- 
geons; and  the  patient  whose  blood,  in  all  probability, 
as  I  believe,  holds  the  secret  for  which  so  many  ages  have 
sought,  is  discharged  as  a  "freak." 

The  surgeon's  interest  in  medical  chemistry  is  prac- 
tically confined,  as  any  one  may  observe  for  himself,  to 
the  examination  of  the  urine  for  albumin  or  sugar,  since 
these  bear  upon  the  suitableness  of  a  patient  for  opera- 
tion. Lately  he  has  learnt  to  examine  the  blood  for  an 
excess  of  white  cells,  since  this  often  indicates  suppura- 
tion somewhere.  That  is  almost  the  limit  of  his  interest 
in  these  fields  of  inquiry. 

Now  we  have  to  learn  that,  though  cancer  has  hitherto 
been  treated  by  the  surgeons  and  left  to  them  to  study, 
it  is  in  no  useful  sense  of  the  words  a  "surgical  disease." 
Dislocations  and  fractures  are  surgical  disorders,  and 
the  genius  of  the  surgeon  is  eminently  suited  to  them. 
But  of  all  known  diseases,  without  exception,  cancer  is 
the  furthest  from  these.  It  is  a  phenomenon  of  cell-life, 
dependent  upon  infinitely  subtle  factors  in  cell-chemistry. 
It  is  a  problem  in  cytology  certainly;  in  cell-chemistry 
certainly ;  in  embryology  certainly,  in  some  cases  if  not  in 
all,  as  will  be  demonstrated  in  the  following  pages :  and 
all  these  things  are  remote  from  the  surgical  province, 
and  commonly  looked  upon  by  surgeons  as  unpractical 
and  visionary.  The  mechanical  aptitudes  or  habits  of 
hand  which  make  a  man  a  good  surgeon,  and  therefore  in 
his  own  province  an  irp\^aluable  member  of  society,  tend 
to  be  psychologically  incompatible  with  the  habits  and 


xiv  PREFACE 

interests  of  mind  which  are  adapted  to  the  study  of  the 
essentials  of  cancer.  The  notions  of  a  specific  form  of 
albumin  or  a  specific  ferment  do  not  interest  the  surgical 
mind,  in  the  absence  of  evidence  that  they  can  be  sewn 
or  excised  or  put  in  splints.  At  this  moment  Prof.  Bier, 
of  Berlin,  who  was  already  famous  as  a  thinker  as  well  as 
an  operator,  is  the  solitary  living  surgeon  of  any  eminence 
who  has  concerned  himself — publicly,  at  any  rate — with 
the  new  mode  of  inquiry  regarding  cancer.  I  desire,  then, 
to  direct  the  attention  of  the  chemist-clinicians,  who  will 
spend  years  of  patient  labor  upon  the  study  of  relatively 
nugatory  problems  of  the  urine  or  the  blood,  to  the 
problem  of  cancer,  and  I  dare  predict  that  the  first  man 
who  will  make  an  exhaustive  study  of  these  fluids  in  a 
case  where  cancer  is  undergoing  spontaneous  cure  will 
enroll  his  name  permanently  in  the  history  of  medical 
science. 

From  surgery  and  the  surgeons,  as  they  have  hitherto 
worked  at  the  problem,  there  is  nothing  more  to  be  hoped. 
They  have  pursued  one  line  of  inquiry  only — the  making 
of  their  operations  extensive  enough  to  effect  an  extirpa- 
tion of  the  disease;  these  operations  have  now  reached 
the  point  at  which,  in  some  instances,  they  kill  outright — 
to  render  the  phrase  "primary  mortality"  in  its  Anglo- 
Saxon  equivalent — more  patients  than  even  survive  for 
the  "three-year  limit" ;  and  it  is  evident  that  no  more  is  to 
be  hoped  in  this  direction.  Surgery  is  literally  "manual 
labor,"  and  manual  labor  will  not  solve  the  problem  of 
cancer. 

The  one  remaining  hope  for  the  surgeons  is  that  the 
principle  of  publicity  regarding  cancer  shall  be  recog- 
nized as  never  heretofore,  so  that  patients  may  come  up 
for  operation  at  the  earliest  possible  stages  of  the  disease. 


PREFACE  XV 

A  great  German  surgeon — great  on  this  account  alone, 
apart  from  any  other — has  done  something  in  this  respect 
by  a  systematic  newspaper  crusade :  and,  two  years  ago, 
I  was  so  convinced  of  the  urgent  necessity  of  some  such 
effort  in  this  country  that  I  asked  a  prominent  Enghsh 
surgeon  to  write  a  volume  on  the  subject,  which  now 
forms  part  of  the  New  Library  of  Medicine.  On  all 
hands  the  surgeons  now  repudiate  the  doctrine  of  non- 
publicity,  which  has  always  found  advocates,  in  theology 
and  medicine  and  science  generally ;  the  doctrine  ex- 
pressed in  the  proverb  about  ignorance  and  bliss  and  in 
Pope's  line  about  a  ''little  learning."  This  doctrine  has 
been  a  curse  and  a  lie  in  all  ages.  A  little  knowledge  is 
the  most  that  any  of  us  can  possess,  and  it  is  of  priceless 
value  compared  with  no  knowledge  at  all.  A  very  little 
knowledge  about  the  first  symptoms  of  cancer  at  the  pres- 
ent day  would  enable  a  few  of  the  best  surgeons  to  save 
many  lives ;  and  the  failure  of  the  surgeons,  until  a  year 
or  two  ago,  to  use  every  means  in  their  power  to  make 
this  little  knowledge  general  is  one  of  the  most  serious 
indictments  that  can  be  made  against  their  profession  in 
the  past. 

But  I  have  many  more  reasons  than  that  already  indi- 
cated for  addressing  this  volume  not  only  to  the  medical 
profession,  but  also  to  the  public  at  large.  For  one,  I 
have  placed  myself  in  what,  so  far  as  I  know,  is  the 
unique  position  of  a  man  who  has  received  a  medical 
education,  and  is  a  continuous  student  of  medicine,  but 
who,  though  not  incapacilated  by  alcohol  or  private 
means  or  old  age  or  illness,  does  not  practice,  I  have 
ceased  to  practice  solely  because  of  the  liberty  which  this 
state  permits  me  in  writing  or  speaking  what  I  believe  on 
medical  subjects  whenever  and  wherever  I  think  fit:  but 


xvl  PREFACE 

the  more  liberty  the  more  responsibility,  and  especially  if 
others  are  not  similarly  placed.  Hence,  I  have  felt  con- 
strained to  write  whenever  and  wherever  I  could  con- 
cerning what  I  believed  to  be  of  public  moment — and  of 
urgent  and  immediate  moment  to  thousands — regarding 
cancer.  Had  it  been  possible  I  should  have  written  not 
merely  in  the  Contemporary  Reviezu  and  Harper's 
Weekly,  for  instance,  but  also  in  the  Hihhert  Journal  and 
the  Police  Nezvs.  And  he  who  would  deny  the  necessity 
of  my  continuing  in  this  course  m.ust  prove  his  contention. 
There  is  some  recent  history  in  the  following  pages  which 
may  or  may  not  help  him. 

A  further  reason  why  in  this  volume  I  have  attempted 
the  all  but  impossible  task  of  writing  for  a  medical  and  a 
non-medical  audience  at  once  is  that  time  is  a  factor  in 
this  question.  If  the  new  study  of  cancer  and  the  new 
methods  of  treatment  based  upon  it  will  help  patients  next 
year  they  may  help  them  to-day,  and  since  cancer  does 
not  wait  for  us  we  must  press  on  with  the  utmost  speed. 
And  if  it  be  necessary  that  patients  or  their  friends  shall 
make  some  of  the  pace  for  the  profession,  then  so  it  must 
be.  If  every  doctor  were  as  keen  about  the  matter  as  if 
he  had  cancer  himself,  other  means  would  suffice. 

A  yet  further  reason  for  employing  wider  and  more 
expeditious  channels  than  would  otherwise  suffice  is  that 
the  progress  of  the  new  study  and  its  appli-cation  to  treat- 
ment must  largely  depend  upon  the  general  practitioner, 
who  does  by  far  the  greater  part  of  the  work  of  the  pro- 
fession for  a  beggarly  fraction  of  its  material  rewards 
and  a  still  smaller  fraction  of  its  honors.  He  works,  if 
he  be  competent,  from  morning  till  night  and  from  night 
till  morning.  It  is  not  his  fault  that  he  has  very  little 
time  for  reading;  and  it  does  not  suffice  that  he  should 


PREFACE 


xvn 


rely  solely  upon  the  leading  medical  journals  for  his 
guidance  in  this  matter.  But  he  will  read  what  the  public 
compels  him  to  read,  and  if  the  public  attention  is 
directed  to  this  book,  I  believe  that  he,  and  therefore  the 
cancer-patient,  will  find  in  it  the  record  of  work  done 
which,  since  it  is  not  of  my  doing,  I  am  free  to  describe 
as  of  priceless  value  in  my  opinion ;  and  also  many  indica- 
tions of  work  remaining  to  be  done  in  which  he  can  share. 

Yet  another  and  urgent  reason  for  publicity,  as  I  show 
in  the  sequel,  is  the  extreme  likelihood  that,  failing  a  pre- 
ventive prophecy,  a  "cancer-serum,"  in  effect  proprie- 
tary, though  not  openly  patented,  and  having  as  its  basis 
some  ferment  or  ferments,  may  any  day  be  put  forward 
and  exploited,  not  in  the  interests  of  the  public,  but  to 
swell  the  pocket  of  some  mercenary,  such  as  neither 
examinations  nor  the  Hippocratic  Oath,  nor  any  conceiv- 
able means  except  the  education  of  the  public,  can  keep 
out  of  the  noble  profession  of  medicine. 

The  addition  of  an  index  would  have  delayed  publica- 
tion for  a  fortnight.  I  apologise  for  its  absence.  One  is 
being  prepared  and  will  be  added  as  soon  as  possible.  The 
price  of  the  book  has  been  kept  as  low  as  possible,  and 
on  this  account  I  have  omitted  to  include  illustrations  of 
the  microscopic  appearances  of  aberrant  germ-cells, 
trophoblast  and  cancer.  I  desire  to  acknowledge  the  help 
received  from  many  editors  on  both  sides  of  the  Atlantic, 
from  my  publishers  for  their  energy  and  sympathy,  and 
from  my  friend  and  literary  agent,  Mr.  Curtis  Brown, 
who  has  been  my  right  hand  in  the  matter  of  obtaining 
publicity  for  more  than  a  year  past.  I  note  also  that, 
when  opportunity  offers,  I  hope  to  arrange  in  a  special 
chapter  the  discussion,  hitherto  neglected,  of  the  blood  in 
cancer. 


xviii  PREFACE 

I  know,  as  a  matter  of  repeated  personal  observation, 
that  the  articles  which  have  brought  me  so  much  abuse 
from  the  Powers  that  Be  in  this  country  have  directly 
led  to  such  boons  for  not  a  few  stricken  patients  as  per- 
fect ease  instead  of  uncontrollable  agony,  and  sweetness 
for  intolerable  foetor :  and  unless  Nature  has  ceased  to 
be  consistent  and  chaos  is  come  again,  I  am  assured  that 
similar  and  greater  results  may  follow  this  book  at  any 
time;  and  that,  if  it  directs  the  attention  of  workers  at 
cancer  to  the  lines  on  which  alone  the  conquest  of  the 
disease  is  to  be  attained,  the  present  gains  in  life  and 
happiness  will  be  as  nothing  to  those  that  will  follow: 
and  it  is  in  this  belief  that,  against  the  urgent  advice  of 
my  friends  and  the  instinct  of  self-protection,  I  send  it 
forth.  The  first  case  of  cancer  I  ever  saw  destroyed  my 
religious  orthodoxy  before  I  left  the  operating  theatre, 
and  seared  my  soul  for  life;  it  is  an  abominable  affront 
to  the  dignity  of  man,  a  disease  that  makes  a  goblin  of 
the  sun  and  almost  brands  the  optimist  of  any  school 
as  a  deliberate  and  imbecile  liar.  If  this  book,  de- 
spite all  its  faults  of  ignorance  or  style  or  taste  or  judg- 
ment, or  any  others — faults  due  in  part  at  least  to  haste, 
for  I  have  believed  myself  to  be  racing  for  life  against 
time — serves  even  in  infinitesimal  measure  to  hasten  the 
end  of  this  most  damnable  thing,  my  life  will  have  been 
worth  living,  though  it  should  end  upon  the  gallows  amid 
universal  execration. 

C.  W.  S. 

13  Greville  Place,  N.  W., 
October,  1907. 


CONTENTS 


PART  L— THEORETICAL 

CHAPTER  I. — Introduction 

le — Money  not  thi 
Individuality  and  progress. 


'No  truth  sterile — Money  not  the  first  necessity  of  science — 


CHAPTER  II.— The  Alternation  of 
Generations 

Instances  from  primitive  forms — Alternation  amongst  ver- 
tebrates, fish  and  chick — The  nature  of  trophoblast — 
The  observation  of  Prof.  Farmer 13 

CHAPTER  III.— Germ-Cells 

The  continuity  of  germ-cells— Work  of  Nussbaum,  Weis- 
mann  and  Beard— Aberrant  germ-cells,  their  origin, 
situation  and  possibilities— The  germ-cell  theory  and 
Cohnheim's  theory 21 

CHAPTER  IV.— Cancer-Cells  and 
Tropj^oblast 

The  cellular  pathology— Cellular  function  and  structure- 
Characters  of  the  cancer-cell,  indefinite  multiplication  and 
specific  digestion— Trophoblastic  cells— Their  cancerous 
behavior— Anatomical  resemblance  between  cancer-cells 
and  trophoblast-cells— Chorio-epithelioma  or  trophoblas- 
xix 


XX  CUJNTKJNTS 

toma — The  condition  of  its  origin — Physiological  re- 
semblance between  cancer-cells  and  trophoblast-cells — 
Production  of  higher  tissues  in  malignant  growth — 
The  relation  between  identical  twins  and  malignant 
growth — Teratomas  and  dermoid  tumors — Recent  im- 
plicit acceptance  of  the  trophoblast  theory  of  cancer. . . 

CHAPTER  v.— The  Pancreas 

Its  position,  function  and  structure — Its  ferments — Their 
origin  and  activation — Their  innocuousness — The  his- 
tory of  the  pancreas  in  the  individual — Its  activity  be- 
fore birth 

CHAPTER  VI. — The  Evolution"  of  the 
Discovery 

The  trophoblast  theory,  1902 — Suggestion  regarding  fer- 
ments,   1904 

CHAPTER  Vn.— The  Immediate  Causes 
OF  Cancer 

The  predisposing  causes — Irritation  as  such  insufficient — 
Possibility  of  reversion  on  the  part  of  the  somatic  cell. 
— Cancer  and  heredity — Cancer  and  failure  of  the  pan- 
creas— The  absorption  of  trypsin  from  the  bowel — The 
case  of  the  "Fletcherite" — Cancer  and  intestinal  decom- 
position    

CHAPTER  VIII.— The  Microscopic  Study 
OF  Cancer 

Failure  of  this  method — Excessive  attention  to  cell  shape — 
The  differences  mere  masquerade — Supersession  of  the 
microscopic  method — Astronomical  analogy  from  the 
telescope  and  the  spectroscope — The  microscopic  method 
now  superseded  by  the  chemical  method 


CONTENTS  xxi 

CHAPTER  IX. — Life  and  Fermentation 

PAGE 

Life  a  series  of  fermentations — The  theories  of  Liebig  and 
Pasteur — The  nature  of  ferments — Their  mode  of 
action — The  specific  nature  of  ferment  action  from  Pas- 
teur to  Fischer 83 

CHAPTER  X. — The  Chemistry  of  Cancer 

Pasteur  the  pioneer — His  work  with  tartaric  acid — The 
asymmetry  of  the  carbon  atom — Dr.  Beard's  specula- 
tion correlating  this  with  the  alternation  of  generations         93 


PART  IL— PRACTICAL 

CHAPTER  XI. — Cancer  and  Surgery 

Recent  advance  in  the  surgery  of  cancer — Its  extraneous 
difficulties — Its  substantial  failure  even  to-day — The 
consequences  of  imperfect  operation,  including  those 
made  for  diagnostic  purposes — The  work  of  Paget  and 
Von  Leyden — ^The  ferments  to  be  employed  in  addition 
to  surgery  when  practiced — -Condemnation  of  imperfect 
operations,  i.e.  nearly  all  operations — Fallacious  beliefs 
regarding  the  results  of  operation — Hope  from  surgery 
existent  in  only  a  minute  percentage  of  cases — The  re- 
sults of  modern  radical  operations — Dr.  Beard's  opinion 
as  to  the  place  of  surgery 109 

CHAPTER  XII. — The  Preparation  of  the 

Ferments 

Grave  and  numerous  difficulties — Most  preparations  now 
on  the  market  worthless — The  standardization  of  the 
ferments — Results  of  tests — The  make-up  of  the  fer- 
ments— The  question  of  dilution — The  question  of  keep- 
ing— Ferments  in  hot  countries — Outlines  of  a  sound 


xxli  CONTENTS 

,      ,     _,  PAGE 

method — Recommendations    to    the    chemists    and    to 

practitioners — This  whole  subject  still  in  embryo 137 

CHAPTER  XIII.— The  Details  of 

Treatment 

Choice  of  preparations — The  oral  administration — Probably 
more  valuable  than  formerly  supposed — Von  Leyden's 
work  on  this  subject — Local  application  and  its  results 
— Hypodermic  application  beset  with  difficulties — Must 
not  be  made  into  the  tumor — The  process  of  steriliza- 
tion— Duration  of  treatment — The  question  of  dosage 
— This  whole  subject  also  still  in  embryo — A  wide  field 
for  inquiry — The  recent  paper  of  Dr.  Gjpeman — The 
use  of  alkalies  as  adjuvants — The  excretion  of  the  fer- 
ments— Possible  prevention  of  cancer 160 

CHAPTER  XIV. — The  General  Action  of 
THE  Ferments 

The  action  of  the  ferments  in  health — Increase  of  weight — 
Trypsin  not  a  poison — Excretion  of  trypsin — The  local 
reaction,  entirely  accidental  and  to  be  avoided  as 
highly  detrimental — The  general  reaction  in  cases  of 
cancer — The  work  of  Dr.  Cleaves — The  "trypto-glyco- 
genic"  reaction — Action  upon  the  kidneys 185 

CHAPTER  XV.— The  German  Work 

The  earlier  work  of  Profs.  Blumenthal  and  Bergell — The 
specific  action  of  trypsin  upon  cancer  in  the  test-tube — 
The  work  of  Prof.  Von  Leyden — Abandonment  of  the 
microscopic  method — The  specific  albumins  of  cancer 
and  their  specific  destruction  by  trypsin — Demonstra- 
tion of  the  absorption  of  trypsin  when  given  by  the 
mouth — Theoretical  questions  involved — Von  Leyden's 
results  by  mouth  administration  and  by  injection  into 
the  tumor — The  specific  action  of  trypsin  on  cancer 


CONTENTS  xxiii 

PAGE 

demonstrated — The  work  of  Schiitze  and  Bergell,  dis- 
proving the  formation  of  anti-trypsin — Von  Leyden's 
later  work  with  a  liver  ferment — His  theory  as  to  the 
origin  of  cancer — The  work  of  Prof.  Bier  with  the  fer- 
ments of  the  blood — Definite  results  obtained — The 
question  as  to  the  origin  of  these  ferments — The  possi- 
ble use  of  normal  human  blood  in  cancer — The  pre- 
liminary report  of  Pinkuss  and  Pinkus — Prolonged 
study  of  injections — Anti-bodies  formed  when  sterile 
solutions  of  decomposed  pancreas  were  employed — No 
anti-trypsin  formation  after  use  of  Fairchild  prepara- 
tions— Results  obtained  in  four  cases — The  authors  pur- 
suing their  inquiry — The  work  of  Blumenthal — The 
specific  nature  and  chemistry  of  the  cancer-cell — The 
specific  action  of  trypsin  upon  it — These  conclusions 
confirmed  by  others 195 

CHAPTER  XVI. — Some  Results  Recorded 
Hitherto 

Dr.  Beard's  results  in  the  mouse — Confirmation  by  Zanoni 
— The  work  of  Odier — The  reports  of  Rice,  Morton, 
Wiggin,  Campbell,  Luther,  Qeaves,  Doran  and  others 
in  America — Recent  results  in  Great  Britain,  the  re- 
ports of  Cutfield,  Meggitt,  Cavanagh  and  Matthews — 
General  comments 234 

CHAPTER  XVII.— The  Claims  of  the 
Treatment 

The  action  of  the  ferments  upon  dead  cancer  tissue — Abso- 
lute freedom  from  danger  when  properly  employed — 
The  relief  of  foetor — The  "relief  of  pain — The  ferment 
treatment  claimed  to  supersede  morphia — The  relief 
of  cachexia — Conditions  that  prevent  success :  previous 
operation,  the  possibility  of  immunizing  the  tumor,  the 
possibihty  of  reversal  of  ferment  action — Applicabil- 
ity to  all  cases — Further  discussion  of  difficulties — The 
influence  of  the  treatment  upon  the  leucocytes — Possible 


xxiy  CONTENTS 

PAGE 

fallacies :  mistaken  diagnosis,  spontaneous  cure — Some 
replies  to  critics 251 

CHAPTER  XVIIL— Some  Warnings 

The  risk  of  a  secret  serum  based  upon  trypsin  and  amyl- 
opsin  or  other  ferments — Secrecy  and  dishonesty  may 
be  regarded  as  equivalent — Warning  against  the  un- 
qualified cancer-quack — Warning  against  the  so-called 
cancer  specialist 285 

CHAPTER  XIX. — Amylopsin  and 
Eclampsia 

Dr.  Beard's  theory  as  to  the  nature  of  eclampsia — Re- 
semblance between  its  symptoms  and  those  which  may 
follow  the  death  of  cancer  under  treatment  by  trypsin — 
Speculation  as  to  the  possibility  that  amylopsin  may  be 
remedial  in  eclampsia 296 


PART  in.— SOCIOLOGICAL 

CHAPTER  XX.— The  Powers  That  Be 

The  conditions  of  progress — Principle  of  authority  in 
science — History  of  ansesthesia,  antisepsis,  inoculation 
for  small-pox,  vaccination  and  hypnotism — The  recent 
behavior  of  the  powers  that  be — The  Medical  Press 
and  Circular — The  Practitioner — The  Hospital — The 
Lancet — The  British  Medical  Journal — The  contrasted 
behavior  of  the  Journal  of  the  General  Practitioner — 
The  Imperial  Cancer  Research  Fund — The  Middlesex 
Hospital  and  its  report —  .       3°3 

CHAPTER  XXL— Conclusion 

Personal  explanation — The  risks  of  officialism — Huxley's 
warning — The  author's  warning  against  himself — The 
value  of  faith  in  science — The  value  of  love  in  science. .       351 


PART  I— THEORETICAL 


THE   CONQUEST   OF   CANCER 


CHAPTER  I 

INTRODUCTION 

I  HERE  propose  to  discuss  at  length  what  I  believe  will, 
in  its  full  fruition,  prove  to  be  one  of  the  most  remarkable 
and  valuable  discoveries  ever  made  by  the  genius  of  man. 
It  is  of  immediate  value,  because  it  already  involves,  in 
some  degree  at  any  rate,  the  relief  of  the  most  horrible 
and  common  of  incurable  diseases,  against  which,  hith- 
erto, the  knife  alone  has  been  of  any  avail — and  that  des- 
perate remedy  itself  almost  invariably  outwitted  at  last. 
But  even  this  discovery  would  not  be  of  such  universal  in- 
terest were  it  not  for  the  many  facts  of  great  significance 
which  have  attended  it — facts  which,  quite  apart  from 
the  humanitarian  question,  bear  upon  the  general  princi- 
ples of  progress  both  as  regards  science  and  as  regards 
society. 

The  work  of  Dr.  Beard,  in  the  first  place,  furnishes  an 
illustration  that  has  never  been  surpassed  of  the  mighty 
truth  that  there  can  be  no  sterile  truth ;  and  it  is  to  this 
great  proposition  that  I  must  devote  the  first  few  pages 
of  my  book.  I  have  no  intention  of  neglecting  the  prac- 
tical aspects  of  the  matter,  and  the  reader  will  have  no 
difficulty  in  turning,  when  he  pleases,  to  my  discussion 

3 


A  THE  CONQUEST  OF  CANCER 

of  them ;  but  in  a  volume  destined  for  the  pubHc,  as  well 
as  the  medical  profession,  they  cannot  take  the  first  place ; 
that  belongs  by  right  to  the  discussion  of  matters  which 
concern  all  who  think,  whether  or  not  they  be  practi- 
tioners of  medicine  or  men  threatened  with  malignant 
disease. 

To  one  who  asked  him  what  was  the  use  of  a  modest 
and  new-born  truth,  the  promise  of  which  for  human  life 
was  apparent  only  to  the  eye  of  philosophic  faith,  Ben- 
jamin Franklin  replied,  "What  is  the  use  of  a  baby?" 
His  question  is  one  of  the  best  answers  on  record.  Yet, 
admirable  though  it  be,  it  is  scarcely  adequate  to  express 
the  fact.  There  are  babies  and  babies,  and  some  of  them, 
whether  from  inherent  or  external  causes,  may  become 
much  worse  than  useless ;  but  of  no  truth  is  this  true,  for 
all  truths  are  of  one  and  the  same  order,  and  that  order 
is  perfection  itself.  Every  smallest  and  meanest  fact  is 
part  of  the  universal  whole.  In  the  world  of  knowledge 
there  is  no  analogue  whatever  to  the  baby  that  is  degen- 
erate or  diseased,  and  there  can  no  more  be  an  ultimately 
useless  truth  than  an  ultimately  useful  lie.  "No  belief 
which  is  contrary  to  truth  can  be  really  useful,"  said  John 
Stuart  Mill,  and  no  belief  which  is  consonant  with  truth 
can  be  really  useless. 

These  things,  of  course,  are  commonplaces.  They  are 
amongst  those  many  commonplaces  which  only  rare  per- 
sons actively  believe.  In  her  war  with  nescience,  science 
needs  money  which,  though  the  least  important  part  of  the 
sinews  of  war — as  we  shall  see — is  yet  not  very  readily 
dispensed  with ;  and  men  are  entitled  to  ask,  when  money 
is  requested  of  them,  whether  or  not  it  will  accomplish 
anything  of  real  value  to  the  life  of  man.  The  poor  we 
have  always  with  us,  and  their  appeals  cannot  be  unheard. 


INTRODUCTION  5 

Is  it  a  warrantable  thing  that  on  this  needy  eartH  men 
and  money  should  be  spent  upon  the  gathering  of  that 
which  is  not  bread?  Must  not  we  distinguish  once  and 
for  all — or  at  least  until  many  of  our  crying  evils  have 
been  silenced  forever — between  useful  and  useless  knowl- 
edge? With  so  little  done  and  so  much  to  do,  is  it  well 
that,  for  instance,  a  man  who  might  be  of  real  immediate 
use  to  the  community  should  devote  years  of  his  life  to  a 
minute  description  of  the  various  stages  in  the  develop- 
ment of  the  skate  or  the  chick  ? 

Only  one  answer,  I  believe,  could  be  returned  to  this 
question,  if  it  were  possible,  as  it  is  not,  to  admit  the 
assumption  that  knowledge  can  be  divided  into  the  useful 
and  the  useless.  I  will  even  admit  to  a  feeling  of  annoy- 
ance at  seeing  men  of  science  attack  problems,  the  solu- 
tion of  which  would  seem  to  be  of  no  immediate  moment, 
whilst  more  vital  matters  remain  neglected.  But  a  case 
like  that  which  we  are  about  to  discuss  should  teach  one 
the  unwisdom  of  these  distinctions.  Not  only  is  there 
no  sterile  truth,  but  it  is  frequently  found  that  facts  which 
seem  to  be  of  the  least  moment  may  be  the  most  fruitful. 
Of  the  development  of  the  skate,  Dr.  Beard  said  to  him- 
self, "Here  are  a  series  of  changes  which  have  never  yet 
been  completely  delineated.  I  will  follow  them  from  the 
beginning  to  the  end."  Not  even  he  could  have  conceiv- 
ably predicted  that  he  would  thereby  be  led  to  the  theory 
of  alternation  of  generations  in  vertebrates,  to  the  tropho- 
blastic theory  of  cancer,  T:o  its  control  by  ferments, 
and,  I  believe,  to  the  initiation  of  a  new  era  of  thera- 
peutics. 

"You  are  wasting  your  time!"  they  said  to  Pasteur, 
a  promising  young  chemist,  when  he  turned  aside  to 
study  the  behavior  of  bacteria.     To  Dumas   and  Biot, 


6  THE  CONQUEST  OF  CANCER 

great  chemists  though  they  were,  it  was  not  given  to  pierce 
the  veil  of  the  future,  and  see  those  pioneer  researches 
blossom  into  the  tree,  the  leaves  of  which  are  for  the 
healing  of  the  nations.  I  place  these  two  instances  side 
by  side  for  their  significance.  As  some  imbecile  critic 
has  remarked,  Dr.  Beard  is  "not  even  a  medical  man"  ; 
nor  was  Pasteur  a  medical  man.  The  chemist,  in  his 
study  of  fermentation,  found  it  necessary  to  inquire  into 
the  behavior  of  microbes.  The  embryologist,  in  his  study 
of  development,  found  it  necessary  to  follow  up  the  life- 
histories  of  certain  kinds  of  cells.  Each  was  follow- 
ing truth  for  her  own  sake;  secure  in  the  faith  that,  if  a 
fact  be  true,  the  question  of  its  utility  is  already  answered. 
Neither  can  have  had  at  first  even  the  glimmerings  of  any 
notion  that  his  work  was  destined  within  his  own  life- 
time and  for  all  ages  to  succeed,  to  close  the  doors  of 
men's  homes  in  the  very  face  of  advancing  death.  But 
such  are  the  rewards  with  which  truth  will  crown  those 
who  follow  her  wherever  she  leads,  without  fear  or  favor, 
and  for  nothing  but  the  love  of  her  beaux  yeux. 

When,  therefore,  we  are  inclined  to  murmur  and  de- 
clare that  this  man  or  that,  working  at  what  appeals  to 
him,  has  no  claims  upon  us,  let  us  remember  such  in- 
stances as  these.  You  cannot  dictate  to  a  man  in 
what  he  shall  find  his  chief  interest.  It  may  be  inexplica- 
ble to  us  that  a  man  should  prefer  to  work  at  this  when 
we  ourselves  would  prefer  him  to  work  at  that,  but  so  it 
is.  These  preferences  will  determine  not  merely  the 
work  in  which  the  worker  is  happiest,  but  the  work  which 
he  does  best ;  and  it  is  the  quality  of  his  work  and  not  its 
subject  matter  that  will  in  the  last  resort  determine  its 
utility.  Mankind  will  therefore  chiefly  profit  when  he 
does  the  work  which  it  pleases  him  to  do.     This  may  be 


INTRODUCTION  7 

of  an  apparently  insignificant,  or  even  trivial,  kind;  it 
may  seem  to  be  as  remote  from  human  life  as  the  re- 
motest star.  It  may  be  destitute  of  that  romance  which, 
in  the  case  of  astronomy,  is  always  added  to  its  unques- 
tionable utility.  The  work  may  deal  with  very  small 
things,  such  as  bacteria,  which  one  can  scarcely  see,  and 
which  the  foolish  will  therefore  suppose  to  be  not  worth 
seeing.  The  worker  may  be  utterly  unable  to  throw  out 
any  large  hints  of  what  his  work  will  achieve ;  he  may,  or 
may  not,  imagine  himself  to  be  a  mere  bricklayer  in  the 
house  of  truth,  but  it  does  not  matter  that  he  cannot 
answer  our  questionings. 

The  only  matters  into  which  we  can  rightly  inquire 
are  these :  Are  the  bricks  well  and  truly  laid  ?  is  the 
workman  honest  with  himself  ?  has  he  an  eye  to  the  main 
chance,  or  is  his  work  its  own  reward?  does  he  record 
what  he  observes,  and  not  what  he  wishes  to  observe? 
does  he  quote  the  evidence  against  his  view  as  well  as  the 
evidence  for  it  ? — in  a  word,  does  he  answer  to  the  defini- 
tion of  Tyndall,  "There  is  in  the  true  man  of  science  a 
desire  stronger  than  the  wish  to  have  his  beliefs  upheld, 
viz.,  the  desire  to  have  them  true"?  If  these  questions 
can  be  answered  as  they  should  be,  we  must  be  satisfied, 
no  matter  whether  the  workman  be  concerned  with 
beetles,  or  skates,  or  double  stars,  or  electrons,  or  savage 
customs,  or  with  the  immediate  treatment  of  some  crying 
evil  of  the  day. 

It  is,  perhaps,  not  chiefly  money,  however,  that  the 
man  of  science  requires,  but  rather  elbow-room  and  re- 
spect. In  these  days  there  can  be  no  question  that  science 
requires  for  its  most  rapid  advance  the  endowment  of 
research,  but  that  is  not  the  great  thing.     Hundreds  of 


8  THE  CONQUEST  OF  CANCER 

thousands  of  pounds  have  been  given  for  cancer  research. 
In  England  a  single  donation  of  no  less  than  £40,000 
was  made  long  after  Dr.  Beard  had  done  his  work.  All 
the  money  thus  given  entirely  failed  to  achieve  the  de- 
sired end.  Worse  than  that,  much  of  it  served  for  a  con- 
siderable period,  and  still  serves,  to  delay  the  recognition 
of  Dr.  Beard's  work  and  the  realization  of  its  value. 
The  worker  who,  single-handed,  made  the  first  great  step, 
did  so  almost  entirely  at  his  own  expense,  and  in  the  hours 
which  he  could  spare  from  his  official  duties.  Almost  all 
the  external  help  he  received  was  a  few  shillings  to  de- 
fray the  expense  of  experiments  on  mice — which  he  un- 
dertook not  in  order  to  verify  his  work,  but  in  order  to 
draw  attention  to  it. 

There  are  many  other  problems,  and  not  only  medical 
problems,  which  still  await  solution  in  the  interests  of 
mankind.  Some  of  them,  the  needs  of  which  are  recog- 
nized, may  have  the  services  of  official  workers,  with 
funds  at  their  disposal  and  high  patronage  behind  them. 
Such  workers  are  to  be  judged  not  by  their  position,  but 
by  the  quality  of  their  work.  Far  be  it  from  me  to  say 
a  word  against  the  accordance  of  public  support  to  such 
enterprises,  but  meanwhile  let  the  educated  public  look 
with  a  discerning  eye  upon  workers  who,  without  encour- 
agement, or  salvoes,  or  stipend,  are  attacking  the  same 
problems.  Their  methods  and  modes  of  approach  may 
be  totally  distinct  from  those  favored  by  the  official  work- 
ers, and  their  opinions  may  be  very  discordant,  but  the 
chances  are  always  in  favor  of  the  amateur  in  the  true 
sense  of  that  word,  as  against  the  hireling.  This  last 
may  also  have  the  love  of  truth,  but  the  amateur  has  noth- 
ing else,  and  his  strength  is  as  the  strength  of  ten  because 
his  heart  is  pure.     He  is  liable  to  be  looked  upon  as  a 


INTRODUCTION  9 

crank.  Simpson  and  Pasteur  and  Lister  were  all  called 
cranks  in  their  day,  and  Dr.  Beard  was  called  a  "cancer 
crank"  in  a  responsible  medical  monthly  long  after  his 
work  was  launched,  and  the  saving  of  lives  had  been 
authoritatively  reported. 

Of  course  a  man  seems  to  be  a  crank  who  has  ideas 
peculiar  to  himself  on  any  subject.  But  when  thousands 
of  students  have  been  working  at  a  problem  for  decades 
and  their  united  labors  have  amounted  to  nothing  sub- 
stantial at  all,  the  man  who  has  peculiar  ideas  is  just  the 
man  who  is  wanted.  Dr.  Beard  has  solved  the  problem 
of  cancer,  as  I  propose  in  this  book  to  show,  because  he 
built  upon  knowledge  peculiar  to  himself — knowledge  of 
his  own  discovering.  All  the  recognized  doors  were 
closed.  Dr.  Beard  made  a  door  of  his  own,  and  forced 
an  entrance  by  it.  Until  the  facts  were  too  many  for 
his  opponents  of  course  he  was  called  a  crank :  naturally 
his  papers  were  refused  by  the  editors  of  the  leading 
medical  journals ;  naturally  the  same  fate  awaited  the  let- 
ters in  which  he  traversed  demonstrably  erroneous,  if  not 
deliberately  false,  statements. 

The  second  great  lesson,  then,  which  we  may  learn 
from  this  case  is  the  old  lesson  which  men  have  been 
taught  from  the  beginning  of  history,  but  which  only  the 
very  few  in  any  generation  have  learnt,  that  individual- 
ity is  the  sole  instrument  of  all  progress,  that  "nothing 
was  ever  yet  done  which  some  one  was  not  the  first  to 
do,"  and  that,  therefore,  the  new  must  always  get  a  hear- 
ing. As  Mill  says,  "G-enius  can  only  breathe  freely  in 
an  atmosphere  of  freedom,"  and  Milton,  pleading  the 
same  cause,  speaks  of  "Liberty,  which  is  the  nurse  of  all 
great  v/its." 

Therefore,    whenever,    or    wherever,    in    matters    of 


10  THE  CONQUEST  OF  CANCER 

science  or  in  any  other  matter,  there  is  heard,  half  stifled, 
a  solitary  voice  saying  that  which  academies  and  cor- 
porations and  churches  and  governments  do  not  say,  I  for 
one  must  prick  up  my  ears.  The  man  is  ipso  facto  a 
crank,  like  Socrates,  and  a  greater  than  Socrates ;  and 
may  be  nothing  more.  But  those  who  have  read  the  his- 
tory of  thought  with  opened  eyes  will  ever  give  a  free 
hearing  to  him  who  can  be  heard  only  with  difficulty,  for 
it  is  from  such  as  he  that  everything  yet  achieved  by  man 
has  proceeded. 

Religious  toleration  is  essentially  a  modern  achieve- 
ment, in  so  far  as  it  has  been  achieved;  and  there  are 
those  who  say  that,  after  all,  it  depends  for  its  existence 
upon  a  fundamental  skepticism.  But  the  history  of 
science  is  no  less  important  and  instructive  in  its  demon- 
stration of  the  supreme  value  of  freedom  of  thought  and 
speech.  And  the  sad  fact  is  that  human  nature,  quite 
apart  from  religious  influences,  finds  tolerance  so  difficult 
even  in  matters  of  science.  The  cry  always  is  "Can  any 
good  come  out  of  Nazareth  ?"  For  years  and  years  Lord 
Rosse's  great  discovery  of  the  spiral  nebulje  was  dis- 
credited by  all  academic  astronomers ;  was  he  not  an  ama- 
teur, and  was  it  not  likely  that  he  had  mistaken  for  a 
nebula  a  spiral  scratch  on  the  object  glass  of  his  tele- 
scope ?  I  have  chosen  an  instance  from  a  remote  science, 
and  one  in  which  the  new  discovery  could  affect  no  one's 
purse.  How  much  more  serious  is  the  case  when  a  great 
corporation  finds  itself  instructed  by  an  outsider,  and 
when  this  instruction  involves  serious  monetary  loss — 
not  necessarily  to  all  the  members  of  the  corporation,  but 
to  those  who  will  not  be  instructed? 

Our  lesson,  then,  is  that  we  must  prove  all  things,  and 
not  least  the  things  which  are  asserted  by  those  who  have 


INTRODUCTION  11 

no  authority  whatever.  If  they  are  wrong  they  will  come 
to  naught;  but  they  may  be  right;  and  beware,  "Lest 
haply  ye  be  found  even  to  fight  against  God." 

In  preparation  for  this  book  I  have  lately  re-read  two 
famous  treatises,  which  would  not  seem,  perhaps,  to  bear 
immediately  upon  the  subject  of  cancer — the  Areopagi- 
tica  of  Milton,  and  John  Stuart  Mill's  essay  On  Liberty. 
The  case  which  we  are  about  to  discuss  might  be  used 
to  illustrate  almost  every  one  of  the  arguments — they  are 
the  same  arguments  in  both  cases — employed  by  these 
two  great  writers.  The  two  points  which  I  have  already 
tried  to  make,  are :  Firstly,  the  value  of  all  truth ;  and 
secondly,  the  importance  of  the  individual  and  his  liberty. 
The  reader  will  find  these  discussed  in  noble  language 
and  with  irresistible  force  by  the  writers  I  have  named. 
He  can  scarcely  realize,  perhaps,  how  strange  was  my 
experience  in  reading  those  two  works  again,  after 
eighteen  months  of  hard  fighting  for  Dr.  Beard.  But, 
after  all,  they  are  accessible  to  any  of  us,  and  the  only 
substantial  value  of  a  contemporary  illustration  of  their 
propositions  is  to  be  found  in  the  fact  that  it  is  contem- 
porary— the  fact  that  men  have  not  yet  learnt  their  les- 
sons. Yet  I  cannot  refrain  from  comment  on  at  least 
two  fine  sentences  from  Milton.  He  says  of  truth,  "Let 
her  and  falsehood  grapple;  who  ever  knew  truth  put  to 
the  worse,  in  a  free  and  open  encounter?  .  .  .  For 
who  knows  not  that  truth  is  strong,  next  to  the  Almighty ; 
she  needs  no  policies  nor  stratagems  nor  licensings  to 
make  her  victorious ;  4:hose  are  the  shifts  and  the  de- 
fenses that  error  uses  against  her  power." 

Now  certainly  the  present  is  a  case  in  point.  Truth 
has  had  no  policies  nor  stratagems  nor  licensings  ;  all  that 
has  been  asked  for  from  the  first  was  a  fair  hearing  and 


12  THE  CONQUEST  OF  CANCER 

a  fair  trial.  On  the  other  hand,  these  shifts  have  cer- 
tainly been  used  against  her,  and  in  forms  as  contempti- 
ble as  they  can  possibly  assume — forms  including  not 
merely  ordinary  misrepresentation  but  the  downright  as- 
sertion of  what  was  not  true.  Yet  truth  is  now  winning ; 
and  her  triumph  is  acknowledged  in  the  United  States 
and  Germany,  if  not  at  home.  Nor  need  we  be  dis- 
pleased, on  the  whole,  with  the  result;  even  though  the 
delay  in  victory  may  still  be  costing  many  valuable  lives. 
After  all,  the  power  of  a  free  press  has  vindicated  itself, 
and  it  would  not  be  easy  to  name  any  great  discovery  in 
therapeutics  that  won  assent  in  a  shorter  time  than  w411 
suffice  for  this. 

So  much,  then,  by  way  of  introduction.  Let  us  now 
trace  from  the  beginning  the  main  steps  of  the  work 
which  will  ere  long  attain  a  splendid  culmination. 


CHAPTER  II 

THE    ALTERNATION    OF   GENERATIONS 

In  the  early  years  of  the  nineteenth  century  there  was 
discovered  the  fact  that  sometimes  a  Hving  organism 
"produces  an  offspring  very  unlike  itself,  which  by  and 
by  gives  origin  to  a  form  like  the  parent."  These  facts 
were  generalized  in  1842  under  the  now  familiar  term, 
"the  alternation  of  generations,"  by  Steenstrup,  who  de- 
scribed the  "natural  phenomena  of  an  animal  producing 
an  offspring,  which  at  no  time  resembles  its  parent  but 
which  itself  brings  forth  a  progeny  that  returns  in  its 
form  and  nature  to  the  parent."^ 

The  alternation  of  generations  usually  involves  what 
Geddes  and  Thomson  define  as  a  "rhythm  between  sexual 
and  asexual  reproduction."  I  quote  what  they  describe 
as  the  clearest  case  of  the  kind : — 

"A  sessile,  plant-like  zoophyte,  which  buds  off  numer- 
ous nutritive  persons,  produces  in  the  warm  months  mod- 
ified individuals  which  are  set  adrift  as  medusoid  per- 
sons. Unlike  the  hydroid  which  bore  them,  these  become 
sexual,  and  from  their  fertilized  ova  an  embryo  develops, 
which  eventually  settles  down  to  start  a  new  sessile  col- 
ony. And  thus  through  the  seasons  we  have  hydroids 
asexually  producing  sexual  medusoids,  and  these  again 
producing  hydroids.     The  life-history  for  two  complete 

^I  am  indebted  for  this  quotation  to  the  admirable  account  of 
this  subject  contained  in  Geddes  and  Thomson's  Evolution  of  Sex. 

13 


14.  (THE  CONQUEST  OF  CANCER 

rhythms  may  be  written  in  the  formula,  in  which  M,  F, 
and  A  stand  for  male,  female,  and  asexual  forms  respec- 
tively : 

M  M  M 

A A ." 

F  F  F 

Many  other  instances  might  be  quoted,  but  they  all 
may  be  included  under  the  above  formula.  In  some  of 
them,  perhaps  the  greater  number,  it  is  the  sexual  gen- 
eration that  is  the  most  prominent,  but  the  embryo  pro- 
duced by  this  generation  is  asexual,  and  from  it  the  sex- 
ual generation  is  again  produced.  In  the  case  of  the 
animal  kingdom  it  is  commonly  asserted  that  alternation 
of  generations  cannot  be  found  above  the  very  humble 
creatures  known  as  tunicates.  In  plants,  however,  this 
alternation,  which  is  extremely  conspicuous  in  many 
cases,  has  been  recognized  more  or  less  easily  throughout 
the  whole  series  of  all  but  the  lowest  forms.  This  is  to 
say  that  even  the  flowering  plants,  including  of  course 
the  trees,  which  occupy  the  same  place  in  the  vegetable 
kingdom  that  the  vertebrates  hold  in  the  animal  kingdom, 
still  display  an  alternation  of  generations.  In  them,  how- 
ever, it  is  the  asexual  generation  or  sporophyte  that  is  so 
extremely  conspicuous,  whilst  the  sexual  generation  is  a 
mere  appendage  to  it. 

It  is  now  more  than  fifteen  years  since  Dr.  Beard  as- 
serted that  even  amongst  vertebrate  animals,  as  amongst 
the  flowering  plants,  there  is  an  alternation  of  genera- 
tions. This  conclusion  was  first  stated  in  a  short  paper 
which  is  now  of  historical  interest.^     References  to  it 

"'A   Supposed   Law   of  Metazoan  Development,"  Anat.  Anz. 
Vol.  8.    Jena,  Gustav  Fischer.     1892. 


ALTERNATION  OF  GENERATIONS       15 

may  be  found  in  the  text-books,  but  they  are  very  brief, 
and  it  is  only  now,  I  suppose,  that  this  paper  will  receive 
the  attention  which  it  deserves.  The  solution  of  the 
problem  of  cancer  was  really  involved  in  that  paper, 
though,  as  I  have  already  hinted,  no  one  could  have  made 
such  a  prediction,  nor  was  Dr.  Beard  concerned  at  that 
time  to  do  anything  but  demonstrate  the  facts  which  he 
had  discovered. 

These  facts  were  really  based  upon  his  study  of  the 
early  development  of  a  fish,  which  he  began  in  September, 
1888.  I  have  before  me,  as  I  write,  twenty-three  papers 
of  various  lengths  which  have  been  published  by  Dr. 
Beard  during  the  last  seventeen  years,  the  first  being 
communicated  by  Professor  Huxley  to  the  Royal  Society, 
and  received  April  20,  1889.  In  that  paper  Dr.  Beard 
first  described  the  presence  within  the  Bill-fish  (Lepid- 
osteus  osseiis)  and  other  fishes,  of  certain  curious  cells, 
which  seemed  to  play  a  temporary  part  in  development 
and  then  totally  disappeared.  This  led  to  the  paper 
above  named,  from  which  I  may  quote  a  few  words. 
After  describing  the  presence  of  the  larval  or  asexual 
form  in  many  of  the  lower  Metazoa,^  and  pointing  out 
"the  analogy  which  would  obtain  between  the  suggested 
mode  of  Metazoan  development  and  the  accepted  fact  of 
an  alternation  of  generations  in  the  life-histories  of  all 
plants  above  the  lowest  Thallophytes,"  Dr.  Beard  says : 

"I  venture  to  attach  most  weight  to  the  application  of 
the  principle  to  the  vertebrata.  ...  It  is  undoubtedly 
the  obstacles  offered  by,  the  phenomena  of  vertebrate 
development  which  have  hitherto  prevented  the  enuncia- 
tion of  the  law  of  development  as  an  alternation  of  gen- 
erations. Larvae  are  so  commonly  encountered  among  the 
'Metazoa  are  all  animals  above  the  simplest  or  protozoa. 


16  THE  CONQUEST  OF  CANCER 

invertebrata  that  the  wonder  is  that  no  one  has  inquired 
why  they  are  so  rare  in  any  guise  in  the  vertebrata."  Dr. 
Beard  goes  on  to  assert  that  larval  structures  can  be 
found  in  several  Amphibia  and  Fishes,  and  that  these 
degenerate.  Speaking  of  one  such  structure,  he  says: 
"It  is  gradually  broken  down  by  some  ferment  action."* 
Dr.  Beard's  conclusion  is  that  "Metazoan  development 
appears  to  me  to  be  by  means  of  an  alternation  of  genera- 
tions in  that,  from  the  fertilized  organism  arises  the 
larva,  upon  which,  in  one  way  or  another,  according  to 
the  circumstances  of  each  case,  a  new  form,  the  adult, 
or  imago,  takes  its  origin."  Fifteen  years  have  elapsed. 
It  has  been  found  that,  just  as,  in  various  of  the  inverte- 
brates, the  egg  gives  rise  to  a  larva  which  does  not 
directly  develop  into  the  new  organism,  but  "serves  as 
the  foundation  on  which  the  development  recommences, 
as  it  were  de  novo" ;  so,  according  to  Dr.  Beard,  in  such 
vertebrates  as  the  skate  and  chick,  there  is  found  to  be  an 
asexual  larval  stage,  upon  which  the  embryo  proper 
develops.  Such  are  the  embryological  beginnings  which 
have  led,  as  we  shall  see,  to  the  discovery  of  a  specific 
and  naturally  appointed  remedy  for  cancer. 

It  is  Dr.  Beard's  belief  that  the  alternation  of  genera- 
tions is  common  to  all  vertebrates,  including  man.  What 
then  becomes  of  the  asexual  stage  or  generation,  since 
there  is  no  sign  of  it  in  the  adult  individual?  In  the 
early  development  of  the  skate  and  the  chick,  Dr.  Beajd 
has  discovered  what  he  calls  a  "critical  period,"  which 
marks  the  beginning  of  the  disappearance  of  the  transi- 
tory larval  generation  that  has  hitherto  been  growing. 
We  may  call  the  characteristic  tissue  of  which  this  struc- 

'We   shall  hereafter  note   the   splendid  triumph  of  this   small 
truth  within  fifteen  years. 


ALTERNATION  OF  GENERATIONS        17 

ture  is  composed  by  the  convenient  name  of  trophoblast. 
Dr.  Beard  appears  to  have  shown  that  up  to  the  critical 
period  in  the  case,  for  instance,  of  the  fish,  all  the  digest- 
ive processes  have  depended  upon  an  acid,  intracellular 
digestion,  very  similar  to  that  which  occurs  in  the 
stomach  of  the  adult.  The  critical  period  is  determined 
by  the  development  in  the  embryo  of  a  new  organ  called 
the  pancreas  (or  sweet-bread).  In  each  of  us  this  is  the 
most  important  organ  of  digesti®n.  It  produces  various 
ferments,  the  most  important  of  which  is  known  as 
trypsin.  This  substance  acts  only  in  an  alkaline,  or 
neutral,  or  very  faintly  acid,  medium,  being  thus  con- 
trasted with  pepsin.  Writing  in  the  Lancet  nearly  three 
years  ago.  Dr.  Beard  said  :^ 

"At  this  epoch,  the  critical  period,  the  fish  commences 
to  feed  itself  on  yolk,  not  by  an  [intracellular]  acid,  peptic 
digestion,  but  by  an  alkaline,  pancreatic  one.  The  com- 
mencing activities  of  the  pancreas  during  foetal  life 
initiate  an  alkaline  digestion  by  the  means  of  the  most 
powerful  and  important  of  all  the  digestive  juices,  the 
pancreatic.  ...  If  the  secretion  be  absent,  neither  the 
asexual  structures  of  a  fish  development  nor  the  cells  of 
chorio-epithelioma  [a  tumor  made  of  normal  trophoblast] 
do,  or  can,  degenerate.  The  solution  of  the  problem  of 
the  functional  relation  of  embryo,  and  trophoblast — how 
the  latter  nourishes  itself  by  an  [intracellular]  acid  diges- 
tion, and  degenerates  slowly  by  a  pancreatic  digestion — 
becomes  at  the  same  time  the  embryological,  if  not  the 
medical,  resolution  of  the  problems  of  malignant  neo- 
plasms.   .    .    ."^ 

"February  4,  1905. 

"In  a  thesis  presented  to  University  College,  London,  by  Dr. 
J.  M.  Hamill,  in  1907,  the  identity  of  trypsinogen,  the  antecedent 
of  trypsin,  in  all  vertebrates  is  demonstrated. 


18  THE  CONQUEST  OF  CANCER 

In  the  above  quotation  there  is  involved  the  whole 
trophoblastic  theory  of  cancer,  and  the  treatment  based 
upon  it.  The  argument  is  that  a  cancer  consists  of 
trophoblast,  and  that  the  digestive  substance  or  substances 
which  cause  the  degeneration  of  normal  trophoblast  will 
also  cause  the  degeneration  of  abnormal  trophoblast.  It 
has  been  my  object  in  the  present  chapter,  however, 
merely  to  discuss  Dr.  Beard's  theory  of  the  alternation 
of  generations  in  the  vertebrates,  including  man,  together 
with  his  assertion  that  the  tissue  called  trophoblast  repre- 
sents the  asexual  generation,  and  the  further  and  all-im- 
portant assertion  that  the  normal  arrest  of  growth  of  this 
tissue,  its  death  and  digestion,  are  due  to  the  activities  of 
the  pancreas,  which,  in  the  case  of  man,  begins  to  func- 
tion actively  at  the  seventh  week  of  development — the 
"critical  period." 

But  let  us  be  perfectly  clear  in  our  minds  as  to  the 
origin  of  this  trophoblast,  on  the  theory  that  it  is  really 
the  asexual  generation  in  man.  This  must  be  clearly 
stated  before  we  can  go  on  in  the  next  chapter  to  discuss 
the  manner  in  which  abnormal  or  irresponsible  tropho- 
blast— in  other  words,  malignant  tissue — is  asserted  by 
Dr.  Beard  to  take  its  origin. 

According  to  the  theory  of  alternation  of  generations, 
the  larval,  asexual  or  trophoblastic  stage  in  the  history 
of  man  arises,  of  course,  from  a  fertilized  germ-cell. ' 
The  common  view  hitherto  has  been  that  the  union  of 
the  sexual  elements  produces  a  new  single  cell  from 
which  the  new  individual  arises,  there  being  no  inter- 
mediate stage.  On  this  new  theory,  however,  we  assert 
that  an  asexual  generation  is  interpolated — in  other 
words,  the  fertilized  germ-cell  does  not  directly  give  rise 
to  a  new  individual,  but  to  this  asexual  stage  or  larva 


ALTERNATION  OF  GENERATIONS        19 

composed  of  the  tissue  called  trophoblast.  The  new  in- 
dividual which  is  to  become  a  human  being  is  the  child 
of  this  larva,  and  actually  arises  in,  and  upon,  it.  The 
larva  is  thus  in  a  sense  its  wet  nurse — to  use  the  term  of 
Steenstrup. 

It  follows,  therefore,  that  it  is  part  of  the  essential  and 
necessary  nature  of  the  germ-cell,  if  it  develop  at  all,  to 
develop  not  directly  into  a  new  human  being,  but  into 
the  tissue  called  trophoblast.  That  assertion  is  involved 
in  the  theory  of  alternation  of  generations.  If,  then, 
there  be  in  any  part  of  a  man's  body — as,  for  instance, 
his  lip — such  a  germ-cell,  and  if  that  germ-cell  be  aroused 
to  growth  and  division  from  any  cause,  it  will  develop 
into  trophoblastic  tissue,  which  will  have  the  essential 
characters  of  normal  trophoblastic  tissue,  and  which,  if  it 
is  to  be  destroyed  at  all,  will  be  destroyed  as  normal 
trophoblastic  tissue  is  destroyed. 

But  plainly,  it  is  necessary  to  inquire  into  the  appar- 
ently wild  assumption  that  a  germ-cell,  capable  of  such 
developments — or  incapable  of  them — should  occur  in  a 
man's  lip.  "Que  diahle  allait-il  faire  dans  cette  galere?" 
That  is  the  question  which  we  must  attempt  to  answer 
in  the  light  of  Dr.  Beard's  work  upon  germ-cells,  which 
is  discussed  in  the  following  chapter. 

Meanwhile,  however,  it  is  desirable,  I  think,  to  look 
a  little  more  closely  into  this  question,  difficult  though 
it  be,  of  the  alternation  of  generations,  as  Dr.  Beard 
recognizes  it  in  the  case  of  the  higher  animals.  Amongst 
other  reasons  for  doing  so  is  the  fact  that  Dr.  Beard's 
theory  beautifully  accounts  for,  and  includes  an  interest- 
ing observation  on,  the  intimate  structure  of  cancer-cells 
as  observed  by  Messrs.  Farmer,  Walker  and  Moore 
in  the  year  1903.     These  observers  were  able  to  recog- 


20  THE  CONQUEST  OF  CANCER 

nize,  in  many  of  the  cells  of  certain  malignant  growths, 
a  characteristic  type  of  division  such  as  had  previously 
been  recognized  to  be  characteristic  of  the  formation  of 
germ-cells.'^  The  special  fact  of  this  division  is  to  be 
found  in  the  nuclei  of  the  cells.  The  stainable  or 
chromatic  matter  in  the  nucleus  of  a  cell  is  broken  up, 
before  division,  into  a  number  of  small  bodies — the  num- 
ber of  which  is  fixed  for  any  species  of  animal  or  plant 
— called  chromosomes,  and  the  peculiarity  of  the  division 
which  is  to  form  a  germ-cell  is  that  the  characteristic 
number  of  chromosomes  is  halved.  At  some  future  date, 
when  the  germ-cell  unites  with  one  from  an  individual 
of  the  opposite  sex,  the  proper  number  of  chromosomes 
is  restored.  It  is  by  no  means  in  every  case  that  this 
characteristic  and  remarkable  type  of  cell  division  can  be 
observed  in  malignant  growths.  We  may  readily  under- 
stand that  it  is  not  every  tumor  which  will  go  so  far  in 
reproducing  the  cycle  of  development.  The  fact,  how- 
ever, is  not  only  explicable  on  Dr.  Beard's  theory,  but 
might  indeed  have  been  predicted  from  it.  He  com- 
mented on  this  fact  in  the  Lancet,  October  29,  1904,  and 
I  will  quote  one  or  two  sentences.  "For  it  is  an  inalien- 
able property  of  the  trophoblast  of  normal  development 
that  upon  it  germ-cells  arise.  Once  these  have  come 
into  existence,  it  is  but  a  question  of  a  certain  limited 
number  of  cell  divisions  before  they  present  the  phe- 
nomena associated  by  many  embryologists  with  the  re- 
duction of  chromosomes.  In  short,  the  proof  furnished 
by  the  researches  of  Farmer,  Moore  and  Walker,  and 
confirmed  by  Bashford  and  Murray,  of  the  occurrence 

^"Resemblance  is  exhibited  by  the  cells  of  malignant  growths  in 
man  and  those  of  normal  reproductive  tissue."  (The  Lancet, 
December  26,  1903,  p.  1830.) 


ALTERNATION  OF  GENERATIONS        21 

of  divisions  in  cancer-  and  sarcoma-cells  usually  asso- 
ciated with  the  maturation  of  germ-cells,  was  the  one 
thing  lacking  to  establish  beyond  question  the  true  nature 
of  a  malignant  tumor  as  the  pre-embryonic  portion  of  the 
life-cycle,  the  asexual  generation.  While  at  present  it 
would  be  wrong  to  assume  that  such  cell  divisions  must 
of  necessity  occur  at  some  time  or  other  in  all  malignant 
tumors,  for  even  a  malignant  tumor  may  conceivably  be 
so  reduced  or  retrograded  as  to  be  unable  to  repeat  the 
whole  cycle  of  the  germ-cells,  just  as  no  tumor  is  known 
to  form  actual  sperms,  it  is  now  beyond  doubt  that  the 
occurrence  of  such  divisions  in  certain  cases  proves  a 
malignant  neoplasm  to  be  the  pre-embryonic  portion  of 
the  life-cycle.  It  is  a  life-cycle  with  the  embryo  omitted. 
Germ-cells  never  do  arise  and  never  could  have  arisen 
from  somatic  or  embryonic  cells  or  tissues." 

If  we  trace  upwards  the  evolution  of  the  vegetable 
kingdom,  we  find  an  important  alteration  in  the  relative 
magnitude  of  the  sexual  and  asexual  generations.  Low 
down  in  the  vegetable  kingdom  the  great  bulk  of  the 
species  is  constituted  by  asexual  generation,  and  very 
little  by  the  other.  But  vegetable  evolution  has  been  ac- 
companied by  a  gradual  increase  of  the  asexual  genera- 
tion, together  with  a  reduction  in  the  importance  of  the 
sexual  generation.  Hence,  in  the  higher  plants  almost 
everything  that  we  notice  is  the  asexual  generation.  This 
is  to  say  that  the  fertilized  egg,  in  the  cells  of  which  the 
full  number  of  chromosomes  has  been  restored,  gives 
rise  to  the  flowering  pl'ant  with  which  we  are  so  familiar. 
On  the  other  hand,  the  sexual  generation  is  merely  repre- 
sented by  the  spore  stage  of  the  plant,  in  which  the  num- 
ber of  chromosomes  is  reduced,  and  which  has  no  free 
existence,  but  remains  enclosed  in  the  tissues  of  the  flow- 


22       ,      THE  CONQUEST  OF  CANCER 

ering  plant  or  asexual  generation  until  fertilization 
occurs.  This,  of  course,  doubles  the  number  of  chromo- 
somes, and  initiates  the  asexual  generation  again. 

Now  what  is  the  case  of  the  animal?  In  it  the  fer- 
tilized Qgg  gives  rise,  as  Dr.  Beard  has  taught  us,  to  the 
trophoblast,  which  is  therefore  the  analogue  of  the  flow- 
ering plant,  though  it  is  as  insignificant  as  the  flowering 
plant  is  conspicuous.  This  trophoblast  has  the  charac- 
teristic of  yielding  germ-cells,  and  on  occasion  these 
may  actually  show  ripening  and  reduction  of  the  chromo- 
somes, as  observed  by  Prof.  Farmer  and  his  associates 
in  the  case  of  cancer.  Normal  trophoblast,  however, 
yields  many  primary  germ-cells,  one  of  which  becomes 
the  embryo,  whilst  the  rest,  as  we  are  about  to  see,  are 
included  within  that  embryo — most  of  them  in  one  special 
spot,  but  some  in  abnormal  situations.  Occasionally  two 
primary  germ-cells  may  develop  completely  and  inde- 
pendently, and  the  result  is  the  production  of  what  are 
called  identical  twins,  two  individuals,  invariably  of  the 
same  sex,  and  extraordinarily  similar  in  physical  char- 
acters. 

I  am  aware  that  this  subject  is  extremely  difficult,  yet 
I  have  only  briefly  alluded  to  it.  For  further  details  and 
for  a  valuable  table  of  the  comparison  between  the  life- 
cycles  of  the  animal  and  the  plant,  the  scientific  reader 
may  be  referred  to  Dr.  Beard's  paper  on  "The  Interlude 
of  Cancer,"  Nezv  York  Medical  Record,  February  2, 
1907. 


CHAPTER  III 

GERM -CELLS 

Several  years  have  now  elapsed  since  Prof.  August 
Weismann,  the  great  biologist  of  Freiburg,  enunciated 
his  famous  theory  of  the  "continuity  of  the  germ-plasm." 
Therein  he  repudiated  a  belief  in  the  continuity  of  germ- 
cells,  and  it  is  in  that  simpler  form  that  we  must  first 
study  the  idea — which  we  owe  to  Nussbaum.  It  is  an 
error  to  imagine  that  the  germ-cells  found  normally  sit- 
uated in  the  body  of  any  of  the  higher  animals  or  plants 
are  products  of  that  body.  On  the  contrary,  they  have 
an  independent  origin.  According  to  Nussbaum's  view, 
if  we  trace  the  normal  development  of  a  fertilized  ovum, 
we  find  that  it  gives  rise  to  two  distinct  sets  of  cells ;  the 
one  set  are  those  which  will  develop  into  the  body  of  the 
individual  with  all  its  various  tissues ;  the  other  set  re- 
main germ-cells  throughout,  so  that  they  are  continuous 
with  the  preceding  germ-cells,  and  though  they  are  in  the 
body,  are  not  of  it.  I  may  quote  the  words  in  which  I 
have  previously  expressed  this  theory.  "Ideally  stated, 
the  sequence — actually  observed  in  many  animals — is  as 
follows:  The  germ-cells  and  the  body-cells  grow  up 
side  by  side.  The  g^erm-cells  are  shed  and  give  rise 
again  to  a  new  body  and  to  their  own  undifferentiated 
descendants,  which  that  new  body  temporarily  shelters. 
The  germ-cells  are  immortal ;  the  individual  is  merely  a 
temporary  host  which  shelters  a  few  generations  of  the 

,     23 


24  THE  CONQUEST  OF  CANCER 

germ-cells,  whose  unbroken  continuity  constitutes  the 
race.  Plainly,  the  likeness  of  daughter  and  mother 
begins  to  be  intelligible.  The  germ-cells  of  the  mother 
— which  will  develop  into  her  daughter — are  directly  con- 
tinuous with  the  cells  which  gave  rise  to  the  body  of  the 
mother.  'As  the  sex-cells  in  an  offspring  are  thus  genet- 
ically continuous  with  [i.e.  directly  derived  from]  the 
parental  sex-cells  which  gave  rise  to  it,  they  will  in  turn 
develop  into  organisms  like  the  parent — a  conception 
fundamental  to  an  understanding  of  inheritance  and  de- 
velopment.' On  this  theory  we  must  regard  each  indi- 
vidual as  merely  the  temporary  host  of  the  continuous 
line  of  germ-cells  which  constitute  the  race." 

Now  though  in  many  of  the  lower  animals  the  actual 
unbroken  sequence  of  the  germ-cells  from  one  generation 
to  another  could  positively  be  detected,  in  higher  animals, 
and  notably  in  most  plants,  it  was  not  thought  possible 
to  recognize  the  germ-cells  until  a  late  period  in  the 
development  of  the  individual.  "In  such  cases,  then,  it 
is  impossible  to  demonstrate  any  continuity  between  the 
germ-cells  of  an  individual  and  the  germ-cells  of  its 
parent.  But  Weismann  has  shown  that  it  is  not,  there- 
fore, necessary  to  abandon  the  invaluable  concept  of  con- 
tinuity. He  very  reasonably  assumes  that  the  essential 
part  of  each  germ-cell  is  not,  for  instance,  the  cell-mem- 
brane, or  the  cellular  shape,  but  a  particular  kind  of  living 
matter — the  germ-plasm.  He  supposes,  then,  that  in  the 
development  of  each  individual  a  portion  of  the  germ- 
plasm  contained  in  the  parental  ovum  is  not  used  up  in 
the  formation  of  the  offspring,  but  is  reserved  unchanged 
for  the  formation  of  the  germinal  cells  of  the  following 
generation.  Though  there  is  not  always  a  continuity  of 
germ-cells  from  generation  to  generation — as  there  de- 


GERM-CELLS  25 

monstrably  is  in  many  animals — there  is  always,  in  all  the 
animals  and  plants  which  display  this  mode  of  reproduc- 
tion, a  'continuity  of  the  germ-plasm.'  From  the  point 
of  view  of  the  race,  the  individual  is  merely  the  ephemeral 
bearer  of  the  immortal  germ-plasm,  which  is  as  old  as  the 
race  and  is  subject  to  no  law  of  death." 

Weismann  employed  the  phrase  "germ-plasm"  since  he 
was  unable  to  demonstrate  the  actual  continuity  of  germ- 
cells  in  every  case.  Dr.  Beard,  however,  believes  that  he 
has  demonstrated  the  actual  continuity  of  germ-cells  as 
cells  from  generation  to  generation  even  in  higher  ani- 
mals. If  we  take  a  special  instance,  such  as  the  smooth 
skate  {Raja  batis),  which  Dr.  Beard  began  to  study 
nearly  twenty  years  ago,  we  find,  according  to  him,  that 
an  actual  continuity  of  germ-cells  is  demonstrable.  When 
he  examined  the  very  young  skate — and  the  same  is  true 
of  many  other  fishes  and  of  the  chick — ^he  found  that  the 
germ-cells  are  by  no  means  confined  to  their  proper  and 
characteristic  site  in  the  body.  He  has  found  them  in 
the  head,  the  skin,  the  gill-region,  the  liver,  the  blood,  "in 
fine,  there  is  hardly  a  place  in  the  whole  trunk  or  head  in 
which  such  aberrant  germ-cells  have  not  been  observed." 
He  has  figured  them  again  and  again.  There  is  no  pos- 
sibility of  mistaking  their  identity  under  the  microscope. 
Where  have  these  aberrant  germ-cells  come  from — these 
cells,  the  malign  possibilities  of  which  are  soon  to  be 
indicated?  The  common  view  would  be  that  they  had 
wandered  from  the  part  of  the  body  of  the  embryo  which 
gives  rise  to  the  germ-cells.  But  to  Weismann  or  Dr. 
Beard  such  an  assertion  is  nonsensical ;  the  germ-cells 
are  older  than  the  embryo.  They  are  not  products  of 
any  part  of  the  body  of  the  individual ;  they  have  arisen 
outside  the  embryo  and  have  migrated  into  it.     Dr.  Beard 


^6  THE  CONQUEST  OF  CANCER 

has  proved  that  this  is  so.  In  the  smallest  embryos  of 
the  skate  no  germ-cells  are  visible.  Later  on  germ-cells 
appear,  but  only  a  very  few  of  them  are  found  in  their 
characteristic  site  in  the  body.  For  instance,  in  embryos 
20  millimeters  long,  50  per  cent,  of  the  germ-cells  are 
misplaced,  whilst  in  embryos  half  as  long  again  only  about 
30  per  cent,  are  misplaced.  In  the  very  youngest  em- 
bryos, containing  no  germ-cells,  hosts  of  germ-cells  are 
to  be  found  lying  in  the  (trophoblastic)  tissue  immediately 
outside  the  embryo  and  preparing  to  enter  it.  In  a  word, 
the  germ-cells  precede  the  embryo,  and  gradually  wander 
into  it  as  it  develops.  ]\Iany  of  the  germ-cells  never  reach 
the  proper  position.  They  wander  along  what  is  called 
the  germinal  path,  but  may  find  themselves  misplaced  in 
all  parts  of  the  body.  Commonly  their  fate  is  to  degen- 
erate, but  apparently  they  do  not  always  do  so. 

It  follows  that  the  germ-cells,  not  being  developed 
from  the  embryo,  are  products  of  the  original  cell  (the 
fertilized  ovum)  which  always  gives  rise  to  the  embryo 
itself.  Thus  the  germ-cells  within  the  embryo  are  its 
own  immature  "twin"  brothers  and  sisters — in  other 
words,  the  embryo  is  the  product  of  one  of  the  prim.arv 
germ-cells,  while  the  remainder  come  to  be  regarded, 
quite  erroneously,  as  its  own  sexual  products. 

Let  us  consider  now  the  case  of  these  aberrant  germ- 
cells  which  Dr.  Beard  finds  in  so  many  parts  of  the  body. 
If  they  do  not  degenerate,  they  may  yet  presumably  lie 
quiescent  throughout  the  whole  life  of  the  individual  that 
nourishes  them.  On  the  other  hand,  they  may  be  roused 
to  development ;  and  so  we  may  ask  ourselves :  "What 
are  the  circumstances  which,  in  a  given  part  of  a  given 
individual,  cause  the  growth  and  multiplication  of  cells 
which  have  always  been  present  in  him,  but  which  have 


GERM-CELLS  ^1 

hitherto  been  quiescent?"  This  question  was  asked,  of 
course,  long  before  the  trophoblastic  theory  of  cancer  was 
advanced,  but  it  is  not  a  question  with  which  Dr.  Beard 
has  concerned  himself  at  all.  Chronic  irritation  seems  to 
be  undoubtedly  one  such  circumstance,  but  there  are 
probably  many  others.  The  new  theory  of  cancer  does 
not  concern  itself  with  this  question ;  at  present  it  in  no 
way  tells  us  anything  not  formerly  known  as  to  the  pre- 
vention of  cancer.  Hence  if  we  are  to  use  the  word 
cause  in  the  ridiculous  fashion  of  common  speech,  which 
assumes  that,  for  any  given  fact,  there  is  only  one  cause 
— as  if  the  universal  past  were  not  the  cause  of  any  one 
fact — we  may  say  that  the  cause  of  cancer  remains  un- 
known. Why  certain  cells,  latent  from  the  first,  should 
multiply  and  become  patent  at  this  place  but  not  at  that, 
in  your  neighbor  but  not  in  you — we  cannot  say.  But  so 
far  as  the  control  of  cancer  is  concerned,  our  ignorance 
does  not  matter.  I  do  not  wish  to  say  anything  so  foolish 
as  that  the  question  of  the  causes  which  arouse  these 
germ-cells  to  develop  is  without  interest.  The  imme- 
diate local  causes  giving  rise  to  cancer  have  long  been 
studied,  and  of  course  it  is  well  that  they  should  be  known 
and  avoided.  General  causes,  also,  have  been  suspected 
— not  general  causes  in  the  sense  that  the  blood  is  in- 
fected and  that  the  disease  has  no  particular  locality,  but 
general  causes  which  may  arouse  the  possibilities  in  a 
given  locality.  By  an  extraordinary  chance  there  has 
lately  been  advanced  the  theory  that  cancer  is  due  to  a 
defect  in  the  activity  of  the  pancreas,  the  trypsin  of 
which,  in  defiance  of  all  the  facts,  was  supposed  to  be 
able  to  digest  glycogen  or  animal  starch.  This  is  the 
so-called  glycogen  theory  of  cancer,  part  of  which  has 
unfortunately  been  transferred  to  the  germ-cell  theory. 


28  THE  CONQUEST  OF  CANCER 

Dr.  Beard,  however,  has  never  declared  that  an  aberrant 
germ-cell  is  roused  to  activity  in  consequence  of  the  with- 
drawal of  the  controlling  influence  of  the  pancreas. 
There  is  no  evidence  to  show  that  the  action  of  the  pan- 
creas is  defective  at  the  start  in  cancer  patients,  though 
this  might  possibly  be  so. 

Assume,  however,  that  from  some  cause  or  other,  more 
frequently  operative,  as  it  appears,  with  advancing  years, 
there  may  develop  and  multiply  an  aberrant  germ-cell 
which  is  such  that  if  its  history  had  taken  a  normal 
course  it  would  have  developed  into  a  brother  or  sister 
of  the  individual  in  whom  it  occurs.  Such  a  cell,  if 
it  develop  at  a  very  early  stage  in  the  history  of  the 
individual — as  may  sometimes  happen,  apparently — may 
form  one  of  those  extraordinary  tumors  which  show 
distinct  signs  of  the  attempt  to  produce  a  second  indi- 
vidual. Such  tumors  are,  as  a  rule,  not  malignant,  but 
they  have  long  been  a  standing  puzzle  to  pathologists. 
It  is  not  possible  here  to  describe  the  extraordinary  cases 
that  are  on  record.  They  include  many  unthinkable 
monstrosities.^ 

Far  more  commonly,  however,  this  aberrant  germ-cell, 
say  in  the  lip  of  an  elderly  man,  reproduces  the  sexual 
stage  or  generation  consisting  of  the  trophoblastic  tissue 
W'hich  we  have  already  discussed.  The  trophoblast 
theory,  then,  asserts,  in  a  word,  that  a  cancer  results 
from  the  attempt  of  an  aberrant  germ-cell  to  continue 
its  life-cycle,  the  attempt  having  ended  merely  in  the 
indefinite  production  of  larval,  asexual  or  trophoblastic 
tissue. 

If  all  malignant  tumors  are  products  of  such  aberrant 
germ-cells,  a  death  from  cancer  is,  so  to  speak,  a  case  of 
^See  the  next  chapter. 


GERM-CELLS  29 

fratricide,  since  the  individual  and  the  tumor  which  kills 

him  are  derived  from  twin  germ-cells. 

If  this  theory  be  correct,  the  conditions  which  lead  to 
the  destruction,  digestion,  and  complete  absorption  of 
the  normal  trophoblastic  tissue  that  begins  to  vanish  at 
the  "critical  period,"  should  have  similar  efifects  upon 
"irresponsible  trophoblast."  In  a  word,  trypsin  should 
cure  cancer  by  killing  and  digesting  its  cells.  The  rest 
of  the  pancreatic  secretion  should  destroy  and  dispose  of 
the  products  of  this  digestion. 

This  germ-cell  or  germinal  theory  of  cancer  must  be 
absolutely  distinguished  from  an  older  theory  to  which 
it  bears  a  superficial  resemblance.  The  view  has  always 
been  popular  and  reasonable  that  the  original  cell  or  cells 
of  a  cancer  were,  from  the  beginning,  different  from 
the  cells  surrounding  them.  The  famous  pathologist, 
Cohnheim,  for  instance,  conceived  the  theory  of  what 
are  called  "embryonic  rests" — the  word  being  better 
translated  as  "residues."  He  supposed  that  during  the 
development  of  the  body  or  embryo,  "some  of  the 
embryonic  cells  which  should  have  gone  to  form  definite 
structures,  get  shut  off,  and  remain  shut  off,  from  the 
rest  of  the  organism.  They  retain  powers  of  prolifera- 
tion and  growth,  and  if  at  any  time  they  exhibit  these 
powers,  cancer  results."  For  instance,  certain  cells  be- 
longing to  the  external  or  epiblastic  layer  of  the  embryo 
might  become  misplaced,  lying  perhaps  in  tissues  formed 
from  a  different  layer,  such  as  the  middle  layer,  or  m.eso- 
blast.  Such  embryonic  residues,  Cohnheim  supposed, 
might  lie  dormant  for  years,  giving  rise  to  trouble  only 
when  some  special  cause  excited  them  to  growth. 

This  theory  agrees  with  Dr.  Beard's  only  in  asserting 
a  special  character  from  the  first  for  the  original  cell  of 


30  THE  CONQUEST  OF  CAN'CER 

a  cancer — a  belief  which  the  recent  work  of  Prof.  BIu- 
menthal  in  EerHn  strongly  confirms.  The  embn,-onic 
theory  asserts  that  this  cell  is  a  cell  from  one  of  the  layers 
of  the  embryo.  The  germ-cell  theory  asserts  that  it  is 
of  much  older  origin  than  that.  It  is  just  precisely  not 
any  cell  of  any  part  of  the  embryo.  It  never  has  been, 
and  never  will  be,  a  proper  part  of  that  individual  at  all. 
It  is  the  possible  beginner  of  a  different  individual.  That 
is  the  fundamental  point :  though  the  parent  cancer-cell 
has  been  in  the  body  ever  since  a  very  early  stage,  it  is  in 
no  proper  sense  a  part  of  the  body. 

Furthermore,  the  tissue  to  which  this  germ-cell  gives 
rise  is  no  more  epiblastic  or  mesoblastic  than  the  germ- 
cell  itself.  It  is  larval  or  trophoblast  tissue,  belonging 
to  the  opposed  stage  in  the  cycle  of  development.  It  may 
imitate  in  certain  cases  various  kinds  of  tissues,  familiar 
to  us  elsewhere,  and  Sir  James  Paget  was  profoundly 
right  vrhen  he  declared  that  cancer  is  an  imitation  tissue. 
It  is  that  and  no  more.  It  is  to  be  hoped  that,  after  this 
explanation,  no  one  will  propose  to  identify  the  embryonic 
theory  of  cancer  with  the  germ-cell  theory;  this  last 
traces  a  cancer  to  a  cell  which,  so  far  from  being  any 
part  of  the  embryo,  is  older  than  any  part  of  the  embryo, 
and  has  actually  travelled  into  the  body  of  the  embryo 
from  without ;  it  states  the  origin  of  cancer  to  be  in  a 
germ-cell,  and  its  nature  to  be  that  of  trophoblast. 


CHAPTER  IV 

CANCER  AND  TROPHOBLAST 

Having  considered  the  chief  characters  of  germ-cells, 
and  stated  Dr.  Beard's  theory  of  their  occurrence  in  ab- 
normal places,  and-  the  possibility  of  their  development 
into  malignant  tumors,  let  us  now  consider  the  charac- 
ters of  the  cells  of  which  these  tumors  consist.  This  is 
evidently  the  logical  place  for  such  a  discussion  in  the 
new  theory  of  malignant  disease,  but  in  point  of  fact 
our  knowledge  of  cancer-cells,  in  nearly  everything  but 
the  one  essential,  is  much  older  than  this  theory. 

We  should  have  long  ago  abandoned  forever — in  its 
older  form,  at  any  rate — the  theory  that  cancer  or  any 
other  disease  is  due  to  disorder  of  the  blood.  It  suffices 
to  observe  that  the  blood  is  itself  a  product  of  the  cells 
of  the  bod}^,  and  that  its  state  does  not  determine  their 
health  or  disease  (except  where  poisons  are  introduced 
into  it  from  without),  but  is  rather  the  index  of  their 
health  or  disease.  We  know  now  that  the  essential  liv- 
ing part  of  every  living  thing  is  composed  of  units 
called  cells ;  and  as  all  physiology — that  is  to  say, 
the  whole  study  of  the  functions  of  the  normal  body — 
must  now  and  hereafter  be  expressed  in  terms  of  the  cell, 
so  all  pathology — or  study  of  disease — ^must  be  similarly 
expressed.  We  owe  the  recognition  of  this  truth,  which 
is  expressed  as  the  "cellular  pathology,"  to  Rudolf 
Virchow.     Now  if  the  conception  of  the  cellular  path- 

31 


32  THE  CONQUEST  OF  CANCER 

ology  is  true  anywhere  it  is  pre-eminently  true  in  the  case 
of  cancer — a  disease  which  consists  in  the  multiplication 
of  certain  living  cells  at  the  expense  of  their  surround- 
ings, and  ultimately  at  the  cost  of  their  host's  death,  and 
their  own. 

These  cancer-cells  vary  very  widely  in  many  charac- 
ters, but  all  agree  in  essentials.  Examined  under  the 
microscope,  those  of  one  tumor  may  show  scarcely  any 
resemblance  at  all  to  those  of  another.  It  may  be  said 
that  almost  every  known  kind  of  cell,  so  far  as  appear- 
ances are  concerned,  may  be  found  in  a  cancer  or  other 
malignant  tumor.  For  many  years  past,  pathologists 
and  surgeons  have  devoted  a  vast  amount  of  labor  to 
the  study  of  the  various  appearances  of  malignant  cells. 
These  appearances  have  led  to  the  coining  of  a  whole 
host  of  names,  and  painstaking  observers  have  sustained 
long  controversies  as  to  whether  this  or  that  kind  of 
tumor  is,  or  is  not,  really  the  same  as  some  other  kind, 
or  whether  it  is  worthy  of  being  ranked  as  a  subrclass 
or  variety,  or  what  not.  These  sterile  discussions  of 
classification  have  been  modified  sometimes  by  the  con- 
sideration of  the  behavior  of  the  cells,  such  as  their  de- 
gree of  malignancy,  but  always  the  chief  subject  of  argu- 
ment and  assertion  has  been  the  appearances  of  the  cells 
as  they  are  seen  under  the  microscope.  Hence,  for  in- 
stance, such  phrases  (which  might  be  multiplied  in- 
definitely) as  round-celled  sarcoma,  spindle-celled  sar- 
coma, squamous-celled  carcinoma,  adenoma,  epithelioma, 
and  so  on.  The  cells  of  some  of  these  tumors  resemble 
nothing  found  in  the  normal  body,  the  cells  of  others 
show  a  striking  resemblance  to  those  of  the  tissues  in 
which  they  arise — this,  indeed,  being  so  marked  in  many 
cases  that  the  resemblance  led  to  the  belief  in  a  real  iden- 


CANCER  AND  TROPHOBLAST  33 

tity  between  the  normal  and  the  morbid  cells,  modified 
only  by  the  exhibition  of  unlimited  growth  on  the  part  of 
the  latter. 

From  the  point  of  view  of  the  student  of  general 
biolog}-,  there  has  always  been  apparent  a  lack  of  insight 
and  of  an  eye  for  essentials  in  these  discussions.  The 
biologist  knows,  having  been  taught  by  Lamarck  and  by 
Spencer  after  him,  that  function  precedes  and  creates 
structure.  This  is  the  historical  fact  of  evolution,  and 
the  historical  fact  of  the  individual  also.  It  always  has 
to  be  reckoned  with,  though  it  is  so  constantly  forgotten 
by  the  physiologist  and  the  pathologist  who,  coming  in 
at  the  end  of  the  process  and  seeing  certain  structures 
associated  with  certain  functions,  can  scarcely  help  fancy- 
ing that  structure  comes  first,  and  that  the  function  is  a 
consequence  of  it.  This  is  an  abstruse  and  fascinating 
question  which  I  cannot  pursue  here,  but  I  would  insist 
upon  what  seems  to  me  to  be  its  pertinence  to  the  matter 
in  hand.  In  the  light  of  Lamarck's  conception  we  shall 
be  more  likely  to  regard  as  unessential  the  various  ap- 
pearances presented  by  cancer-cells,  reminding  ourselves 
that  their  structure,  as  in  the  case  of  all  living  things,  is 
merely  a  means  adopted,  and  adapted,  for  the  purpose  of 
displaying  their  vital  functions  :  and  we  shall  proceed  to 
ask  ourselves  what  those  vital  functions  are. 

Then  it  is  that,  despite,  for  instance,  their  resemblance 
under  the  microscope,  we  begin  to  realize  how  profoundly 
the  cells  that  look  like  gland-cells  in  a  particular  cancer, 
differ  from  the  cells  that  are  gland-cells  among  which  it 
is  growing.  It  used  to  be  said  that  the  malignant  cells 
differed  merely  in  having  broken  loose  from  the  general 
bodily  control.  The  process  was  a  local  rebellion.  These 
phrases    are    trivial    and    nonsensical — once    questioned, 


84  THE  CONQUEST  OF  CANCER 

they  are  doomed.  Brushing  aside  all  the  resemblances 
in  structure — resemblances  which  are  not  at  all  to  be 
found  in  many  cases,  be  it  remembered — we  begin  to 
realize  that  the  essentials  of  vital  behavior  in  the  case  of 
the  body-cell  and  the  cancer-cell  are  radically  opposed. 
What  then,  are  the  characters  of  the  cancer-cell,  it  being 
granted  that  we  are  to  think  of  essentials  and  not  of  the 
mere  outline  architecture  of  the  cell? 

These  characters  have  long  been  known  in  a  general 
way,  though  it  was  left  to  the  individual  genius  of 
Dr.  Beard  to  explain  them.  If  it  be  adequately  nour- 
ished from  without,  the  cancer-cell  is  capable  of  indefinite 
multiplication.  It  is  of  an  extremely  low  order  of  de- 
velopment, and  is  almost  incapable  of  differentiating 
itself.  The  blood-vessels  within  the  midst  of  a  cancer 
have  invariably  grown  into  it  from  without;  no  cancer- 
cell,  so  long  as  it  remains  a  cancer-cell,  is  capa- 
ble of  giving  rise  to  anything  but  another  cell  like 
itself.  This  general  absence  of  any  power  of  differ- 
entiation is  an  extremely  marked  and  significant  charac- 
teristic. The  cancer-cell  is  also  distinguished  by  its  high 
vitality:  but  though  it  produces  substances  which  enable 
it  to  destroy  every  living  tissue  with  which  it  comes  in 
contact,  and  even  the  lifeless  structure  which  forms  part 
of  bony  tissue — yet  it  is  itself  readily  susceptible  to  the 
action  of  certam  deleterious  agencies.  Cancer-cells  die 
in  large  numbers,  for  instance^  as  the  result  of  the  attacks 
of  microbes,  thus  giving  rise  to  many  of  the  most  dis- 
tressing symptoms  of  the  disease,  and  producing  danger- 
ous substances  which  are  absorbed,  causing  the  chronic 
poisoning  of  the  patient.  It  has  been  attempted,  without 
success,  to  destroy  cancers  by  the  injection  of  bacterial 
poisons. 


CANCER  AND  TROPHOBLAST  35 

But  we  have  not  yet  emphasized  what  is  the  most 
marked  and  the  most  deadly  characteristic  of  the  cancer- 
cell.  The  phrase  indefinite  multiplication  does  not  at  all 
sugg-est  this  characteristic.  Cells  may  multiply  indef- 
initely, and  cause  huge  tumors,  constituting,  perhaps,  a 
nuisance  by  their  weight  or  their  pressure — and  yet  these, 
not  having  the  essential  character  of  cancer-cells,  are 
merely  innocent  or  "benign"  tumors.  Similarly  also, 
cells  multiply  in  every  case  of  local  or  general  inflamma- 
tion. Paying  too  much  attention  to  this  multiplication, 
many  pathologists  and  surgeons  have  endeavored  to  dem- 
onstrate a  real  identity  between  the  phenomena  of  in- 
flammation and  of  benign  and  malignant  tumors.  But 
there  remains  a  real  differentia — which,  it  is  true,  makes 
the  indefinite  multiplication  possible,  but  which  is  not 
found  in  association  with  other  cell  multiplications.  The 
cardinal  fact  of  the  cancer-cell  is  that  in  the  course  of  its 
life,  quite  apart  from  its  multiplication,  it  digests  and 
destroys  the  living  cells  of  the  individual  in  whom  it  is 
groiving.  This  it  seems  to  do  in  virtue  of  the  possession 
of  a  ferment  which  was  discovered  by  Eugen  Petry  in 
1899,  and  which  Dr.  Beard  has  called  malignin.  This 
acts  in  an  acid  medium,  and  it  seems  to  be  certain  that 
the  fluids  proper  to  a  cancer  are  possessed  of  an  acid 
reaction.  Now  we  have  arrived  at  something  real  and 
significant,  as  distinguished  from  any  mere  question  of 
the  shapes  of  cells.  We  have  ascertained  a  fundamental 
fact  as  to  the  function,  as  to  the  essential  vital  behavior, 
of  the  cancer-cell.  After  all,  the  failure  of  the  previous 
observers  was  only  due  to  the  natural  tendency  which 
we  all  display  in  forming  our  first  judgments  of  men  as 
well  as  cells.  But  just  as  the  real  nature  of  a  man,  the 
real  man,  is  not  constituted  by  his  shape,  but  by  what  he 


36  THE  CONQUEST  OF  CANCER 

is  and  does,  so  also  the  real  nature  of  a  malignant  cell  is 
forever  hidden  from  the  microscope.  We  know  the 
cancer-cell  not  by  its  outline,  but  by  its  acts. 

Dr.  Beard,  then,  was  well  content  to  leave  to  others 
the  discussion  of  the  shapes  of  cancer-cells,  whilst  he, 
having  recognized  the  triviality  of  that  question,  could 
proceed  to  think  about  them  in  terms  of  their  essentials. 
A  cancer-cell,  large  or  small,  round  or  spindle-shaped, 
is  always  a  cell  which  thrives  by  eating  into  the  tissues 
around  it,  and  in  the  course  of  its  growth^  thus  achieved, 
divides  and  multiplies. 


Trophoblastic  Cells 

None  of  the  facts  Just  stated  were  discovered  by  Dr. 
Beard.  Except  for  the  recognition  of  the  cancer  ferment, 
they  have  all  been  known  for  many  years.  His  advan- 
tage in  their  contemplation  merely  lay  in  the  fact  that  he 
looked  at  the  essentials.  In  point  of  fact,  it  has  long 
been  evident  to  all  who  thought  for  themselves  that  the 
cancer  problem  was  a  problem  of  cell  chemistry.  Here 
were  certain  cells  which,  whatever  they  looked  like,  were 
fundamentally  different  from  the  ordinary  cells  of  the 
body.  The  difference  was  one  of  function,  to  be  ex- 
pressed in  chemical  terms,  and  of  course  it  follows  that 
there  must  necessarily  be,  if  we  could  find  it,  or  make  it, 
at  least  one  substance  which  would  interfere  with  the 
chain  of  chemical  reactions  in  the  case  of  the  one  kind 
of  cells,  whilst  it  would  not  interfere  in  the  case  of  the 
others.  This  proposition  is  a  necessary  inference  from 
the  assumption  of  a  fundamental  difference  in  chemistry, 
which  was  in  its  turn  an  inference  from  the  observed 


CANCER  AND  TROPHOBLAST  37 

facts  of  difference  in  vital  behavior.  Dr.  Beard  has 
found  the  substance  in  question — or  one  such  substance — 
as  will  be  proved  up  to  the  hilt  in  the  sequel ;  and  he  has 
found  it  because  of  no  lucky  chance,  but  because  of  his 
previous  researches  in  embryology.  His  study  of  the 
vital  characters  of  the  cancer-cells  suggested  to  him  as 
irresistible  the  belief  that  these  cells  are  fundamentally 
identical  with  the  cells  composing  the  tissue  called  tropho- 
blast,  and,  therefore,  he  argued,  that  zuhich  normally  ar- 
rests the  growth  of  a  trophohlast  must  therapeutically 
arrest  the  grozvth  of  a  cancer. 

The  cells  composing  trophoblastic  tissue  are  highly 
uniform  in  their  behavior  and  also  in  their  appearance. 
Let  us  consider  first  of  all  their  behavior,  which,  as  we 
have  insisted,  is  all-essential.  Like  the  cells  of  a  cancer, 
the  cells  of  a  trophoblast  multiply  indefinitely.  That 
is  important  so  far,  but  it  is  by  no  means  conclusive  in 
any  way,  since,  as  we  have  seen,  indefinite  multiplication 
of  cells  is  found  in  circumstances  utterly  different  from 
those  we  are  considering.  Trophoblastic  cells,  again,  like 
cancer-cells,  are  of  an  extremely  low  order  of  develop- 
ment, and  do  not  show  any  general  differentiation  into 
tissues.  Most  important  of  all,  the  cells  of  a  trophoblast 
thrive  and  multiply  by  eating  into  the  surrounding  struc- 
tures— these  in  normal  development  being  maternal  struc- 
tures. This  attack  upon  maternal  structures  is  absolutely 
indistinguishable  from  the  attack  of  a  cancer  upon  its 
surroundings,  and  possesses  all  the  same  essential  fea- 
tures.   The  identity  is  admitted  by  all  recent  students. 

Yet,  again,  the  mere  appearance  of  trophoblast  has  a 
most  significant  resemblance  to  the  appearance  of  certain 
malignant  tumors.  Dr.  Beard  has  long  asserted  what, 
indeed,  is  evident  to  any  one  who  will  look  for  himself, 


38  THE  CONQUEST  OF  CANCER 

that  it  is  absolutely  impossible,  even  under  the  highest 
powers  of  the  microscope,  or  by  the  use  of  any  variety 
jf  staining  dyes,  to  distinguish  between  specimens  of 
trophoblast  and  specimens  admittedly  taken  from  certain 
typical  and  malignant  tumors.  Such  tumors  present  ap- 
pearances utterly  unlike  those  of  any  normal  tissue  except 
trophoblast,  whilst  from  it  they  cannot  be  distinguished. 
Fail  to  mark  the  slides  you  prepare,  and  if  once  you  mix 
them  you  can  never  sort  them  out  again. 

Hence,  again,  the  proposition  that  the  substance  of  a 
malignant  tumor  is  trophoblastic. 

If  normal  trophoblast,  then,  begins  to  degenerate  and 
disappear  at  the  very  time  when  the  pancreas  of  the 
developing  individual  first  shows  signs  of  activity — -as 
proved  by  microscopic  examination  of  its  cells — may  it 
not  be  that  it  is  the  activity  of  the  pancreatic  secretion 
which  effects  the  digestion  of  normal  trophoblast?  Dr. 
Beard  had  long  known  that,  to  take  the  case  of  man, 
the  critical  period,  as  he  calls  it,  occurs  at  the  seventh 
week,  and  he  had  also  known,  as  a  fact  of  another  subject, 
so  to  speak,  that  the  pancreas  shows  its  first  signs  of 
activity  at  the  seventh  week.  But  it  was  not  until  the 
coincidence  in  time  was  presented  to  his  mind,  with  the 
immediate  suggestion  of  more  than  coincidence  between 
the  two  facts,  that  he  saw  the  light.  For  if  the  pan- 
creatic secretion  digests  and  destroys  normal  trophoblast, 
it  must  also  be  capable  of  destroying  abnormal  or  irre- 
sponsible trophoblast,  already  believed  by  him  to  be  the 
proper  definition  of  a  cancer. 

At  this  point,  however,  the  critical  reader  will  very 
properly  observe  that  it  is  not  for  me,  who  have  insisted 
upon  the  relative  insignificance  of  the  mere  appearance 


CANCER  AND  TROPHOBLAST  S9 

of  cancer-cells  under  the  microscope,  to  lay  much,  if  any, 
stress  upon  the  structural  resemblance  between  tropho- 
blastic cells  and  those  of  certain  malignant  tumors:  and 
I  admit  the  validity  of  the  objection.  But  we  have 
already  observed  that  normal  trophoblastic  tissue  eats 
into  the  maternal  structures  which  surround  it,  and  now 
yve  have  to  observe  the  proved  and  accepted  fact  that 
normal  trophoblast  may  give  rise  to  a  malignant  tumor. 
Not  very  many  years  have  passed  since  pathologists  first 
identified  the  appalling  kind  of  tumor  which  is  now  called 
chorio-epithelioma.  Under  certain  conditions  this  may 
arise  during  pregnancy.  Its  origin  is  in  the  womb,  which 
it  attacks,  and  from  which  it  spreads,  by  the  lymph- 
vessels  and  the  veins,  to  various  parts  of  the  body,  often 
giving  rise,  for  instance,  to  secondary  growths  in  the 
lungs,  or  brain,  or  both.  Formerly  chorio-epithelioma 
was  supposed  to  be  divisible  into  a  malign  and  a  benign 
variety,  but  now  it  is  believed  that  the  disease  is  always 
essentially  malignant.  Further,  chorio-epithelioma  is 
now  recognized  as  the  most  malignant  of  all  tumors. 

Its  name  is  derived  from  the  chorion,  one  of  the  struc- 
tures peculiar  to  the  developing  foetus.  This  chorion 
helps  to  form  the  placenta,  or  "after-birth" — a  cake-like 
organ  which  furnishes  the  connection  between  the  de- 
veloping foetus  and  the  mother.  The  placenta  is  usually 
described  as  consisting  of  a  maternal  and  a  foetal  por- 
tion. The  latter  is,  in  part,  developed  from  the  mem- 
brane called  the  chorion.  The  external  portion  of  the 
chorion  consists  of  a  layer  of  cells — the  "trophoblast"  of 
Hubrecht — which  have  the  business,  in  virtue  of  their 
peculiar  and  significant  power,  of  eating  into  the  tissue 
of  the  womb  at  the  spot  where,  as  the  result  of  this 
process,  the  placenta  will  be  formed.     Sometimes,  how- 


40  THE  CONQUEST  OF  CANCER 

ever,  this  process  is  not  limited,  as  it  should  be,  but  the 
trophoblastic  cells  continue  their  destructive  work,  and 
then  constitute,  as  I  have  said,  a  chorio-epithelioma  so 
called — much  better  named  trophoblastoma.  It  is  a 
known  fact,  then,  that,  whether  or  not  cancers  in  general 
are  made  of  trophoblastic  tissue,  there  is  one  form  of 
cancer  which  is  certainly  so  made.  It  possesses  in  pre- 
eminent degree  the  characteristic  and  essential  properties 
of  cancerous  tissue — ^the  power  of  unlimited  growth,  and 
the  power  of  digesting,  or  breaking  down  by  ferment 
action,  the  tissues  in  its  neighborhood.  It  also  possesses 
in  high  degree  the  power  of  forming  secondary  growths. 

I  have  said  that,  normally,  the  development  of  the 
trophoblast  is  limited,  and^  recognizing  its  power  of  un- 
limited multiplication,  we  must  ask  what  it  is  that  limits 
it.  The  answer  given  by  Dr.  Beard,  as  we  have  seen, 
is  that  it  is  the  activity  of  the  pancreas — which  is  known 
to  be  active  before  birth,  though  it  has  no  food  to  digest 
— that  results  in  the  formation  of  trypsin  and  the  degen- 
eration of  the  trophoblast. 

Now  if  this  answer  be  the  true  one,  we  must  expect 
to  find  certain  facts  of  the  pancreas  associated  with  those 
known  cases  in  which  the  trophoblast  does  not  cease  to 
develop  as  it  should,  but  continues  to  grow  and  multiply, 
first  in  the  wall  of  the  womb,  and  later  in  the  mother's 
body  generally.  What,  then,  are  the  cases  in  which 
chorio-epithelioma — or  trophoblastoma,  as  it  should  really 
be  called — does  develop?  They  are  cases  in  ivhich  the 
foetal  pancreas  does  not  perform  its  function.  This  tumor 
arises  in  cases  where  the  embryo  dies  before  the  critical 
period,  or  where  the  foetus  or  embryo — the  name  given 
to  the  child  in  its  earliest  stages — is  expelled  prema- 
turely, leaving  its  chorion  behind  it,  or  in  cases  where  the 


CANCER  AND  TROPHOBLAST  41 

foetus  undergoes  mal-development,  so  that  its  pancreas 
is  not  formed  and  active.  Of  all  the  theoretical  argu- 
ments for  Dr.  Beard's  view,  there  is  none  more  cogent 
than  this — that  a  kind  of  tumor,  admittedly  cancerous  in 
all  essentials^  arises  from  normal  trophoblastic  tissue  in 
certain  cases  of  pregnancy,  zvhere  the  pancreas  of  the 
child,  for  one  reason  or  another,  is  not  in  action.  This 
is  the  fact,  and  in  the  light  of  our  other  knowledge  it 
admits  of  only  one  interpretation.^ 

There  are  a  number  of  further  facts  for  which  an  inter- 
pretation is  now  provided  by  the  theory  that  cancer-cells 
and  cells  of  the  peculiar  reproductive  tissue  called  tropho- 
blast  are  essentially  identical.  I  will  here  note  some  of 
these. 

It  is  admitted  that  the  Rontgen  rays  in  certain 
cases  have  a  specific  toxic  action  upon  cancer-cells,  just 
as  trypsin  has.  Now  the  Rontgen  rays  have  also  been 
shown  quite  lately  to  have  a  specific  toxic  action  upon 
the  characteristic  cells  of  the  reproductive  organs,  so  as 
actually  to  cause  sterility,  whether  in  the  male  or  the 
female.  We  realize  now  the  complete  erroneousness  of 
the  old  assumption  that  the  cells  of  the  reproductive 
organs — -such  as  the  ovary,  which  is  significantly  one  of 
the  commonest  sites  of  tumors — are  to  be  regarded  as 
passive  except  on  special  and  exceptional  occasions. 
We  know  now  that  continuous  processes  of  great  com- 
plexity and  importance  occur  in  these  organs  during  the 
reproductive  ages.  In  our  present  state  of  ignorance 
regarding  their  nature  I  can  do  no  more  than  merely 
note  the  fact — which,  like  all  other  facts,  must  have  an 

^I  believe  it  will  be  generally  recognized,  before  long,  that  the 
so-called  "myxoma  of  the  chorion"  is  only  a  less  malignant  form 
of  chorio-epithelioma,  and  that  its  development  from  the  tropho- 
blast  depends  upon  similar  conditions. 


4«  THE  CONQUEST  OF  CANCER 

interpretation — that  one  and  the  same  agent,  the  Rontgen 
ray,  has  a  specific  action  both  upon  malignant  cells  and 
upon  some  stage  or  other  in  the  life-history  of  germ- 
cells. 

Here  also  I  will  state  again,  on  account  of  its  impor- 
tance, the  remarkable  resemblance  in  behavior  between 
the  process  of  erosion,  as  it  is  seen  in  a  cancer,  and  the 
process  of  erosion  by  which  the  trophoblastic  tissue,  or 
chorionic  epithelium,  in  normal  pregnancy,  eats  its  way 
into  the  tissues  of  the  uterus. 

Further,  we  m.ust  note  the  extremely  high  vitality  of 
the  cancer-cell.  The  almost  universal  teaching  hitherto 
— and  most  amazing  teaching  it  is — ^has  been  that  the 
cancer-cell  is  of  very  low  vitality.  This  opinion  would 
seem  to  depend  upon  the  fashion  in  which  exposed 
tumors  are  attacked  by  the  germs  of  suppuration  and 
putrefaction.  But  if  we  consider  for  a  moment  what  the 
history  of  cancer  is,  we  recognize  at  once  that  an  ex- 
traordinarily high  vitality  is  a  chief  character  of  the  can- 
cer-cell. Now  it  shares  this  character  with  the  cells  of 
trophoblast,  the  powers  of  which  we  have  already  noted, 
and  especially  their  character  of  unlimited  reproduction. 

An  immensely  significant  fact,  the  importance  of  which 
it  is  impossible  to  overestimate,  is  that  certain  kinds  of 
malignant  tumors  are  capable  of  developing  in  them 
higher  elements,  such  as  even  cartilage,  bone  and  primi- 
tive muscle.  I  regard  this  fact  as  absolutely  conclusive 
in  its  indications.  No  tissue  in  the  higher  animals  but 
germinal  tissue  could  conceivably  do  such  a  thing;  no 
other  tissue  could  conceivably  have  in  it  the  potentialities 
— "determinants,"  to  use  the  phraseology  of  Weismann 
— of  these  highly  differentiated  structures.  It  is  notably 
the  kind  of  malignant  tumor  usually  described  as  the 


CANCER  AND  TROPHOBLASl  43 

large  spindle-celled  sarcoma  that  sometimes  evolves  these 
higher  tissues  within  it. 

I  have  mentioned  elsewhere,  but  repeat  here,  the  dem- 
onstration that  the  cells  of  a  cancer  frequently  divide 
in  a  peculiar  and  highly  characteristic  fashion,  formerly 
thought  to  be  peculiar  to  the  processes  of  cell  division 
that  lead  up  to  the  formation  of  mature  germ-cells.  Now, 
according  to  Dr.  Beard's  theory,  cancer  as  trophoblastic 
tissue  should  be  expected  occasionally  to  demonstrate  the 
power  of  giving  rise  to  germ-cells. 

The  commonest  site  of  tumors  is  the  germ-cell  tissue 
— that  is  to  say,  the  specific  cells  of  the  ovary. 

For  myself  I  do  not  care  to  exclude  the  possibility  that 
in  somiC  cases  cancer  may  arise  in  cells  which  were 
formerly  proper  tissue-cells  of  the  part  in  question,  but 
which  from  some  cause  or  another  have  undergone  a 
reversion  to  the  germ-cell  state.  The  student  of  cell-life 
will  not  find  such  a  conception  incredible.  In  this  con- 
nection I  would  note  that  malignant  tumors  have  never 
been  found  to  occur  in  three  tissues — namely,  in  fatty 
or  adipose  tissue,  in  striped  muscular  tissue  and  in 
nervous  tissue.  (Tumors  of  the  brain  arise  never  from 
the  nervous  elements,  but  from  the  connective  tissue  ele- 
ments— which  bear  the  same  relation  to  the  nerve-cells 
as  a  house  does  to  its  inhabitants.)  Now  these  three 
kinds  of  tissue  are  probably  the  most  highly  differentiated 
in  the  body ;  differing  as  widely  as  possible  in  all  other 
respects,  they  agree  in  this.  The  nerve-cell  is  so  much 
differentiated  and  specialized  that  it  is  quite  incapable 
of  multiplication — in  accordance  with  Spencer's  famous 
law  of  the  antagonism  between  individuation  and  genesis. 
The  same  is  probably  true  of  the  striped  muscle-cell, 
there  beino^  reason  to  believe  that  when  a  muscle  is  devel- 


44  THE  CONQUEST  OF  CANCER 

oped  by  exercise,  the  previously  functioning  cell-fibres 
do  not  divide,  the  growth  being  due  to  the  development 
of  small  round  cells  which  had  not  previously  developed. 
Hence  there  is  a  limit  to  the  growth  of  every  muscle  as 
to  the  growth  of  every  brain.  As  for  the  fat-cell,  it  has 
almost  specialized  itself  to  extinction,  very  nearly  the 
whole  of  its  bulk  consisting  of  lifeless  oil.  It  seems  to 
me  that  we  may  perhaps  understand  why  it  is  that  malig- 
nant tumors  never  arise  in  these  three  tissues,  if  we 
assume  the  process  of  specialization  to  have  gone  so  far 
that  reversion  to  the  primitive  state,  common  to  all  of 
them,  is  impossible.  This  suggestion  is  merely  thrown 
out  for  what  it  may  be  worth,  and  I  am  quite  aware  that, 
if  there  is  anything  in  it,  it  involves  the  modification  of 
some  non-essential  parts  of  Dr.  Beard's  theory. 

One  other  remarkable  fact,  first  discussed  by  Dr. 
Beard,  bears  very  closely  on  this  question  of  the  relation 
between  reproductive  and  malignant  tissue.  It  is  that 
every  stage  can  be  traced,  or  at  any  rate  that  every  inter- 
mediate condition  has  been  observed,  between,  on  the 
one  hand,  unquestionably  malignant  growths,  and,  at  the 
other  extreme,  the  production  of  what  are  called  identical 
twins — twins  invariably  of  the  same  sex,  and  not  infre- 
quently all  but  indistinguishable  from  one  another.  Now 
Dr.  Beard  has  been  asserting  for  years  that  a  malignant 
tumor  arises  from  a  germ-cell,  such  that  if  it  had  under- 
gone normal  development  at  the  proper  time,  it  would 
have  been  the  twin  brother  or  sister  of  the  individual  in 
whom  the  tumor  arises.  I  will  confess  that  when  first 
I  met  that  statement  of  Dr.  Beard's,  it  seemed  to  me  too 
wild  and  bizarre  for  credence;  yet  now,  as  I  have  said, 
we  have  the  recognized  and  accepted  fact  that  the  stu- 
dents of  these  matters  have  observed  all  staeres  between 


CANCER  AND  TROPHOBLAST  45 

say,  a  malignant  tumor  of  the  ovary  at  the  one  extreme, 
and  identical  twins  at  the  other. 

The  countless  varieties  of  monstrosity,  such  as  the  in- 
clusion of  one  more  or  less  imperfect  and  "parasitic"  twin 
wathin  another,  pass  by  gradual  stages  in  one  direction 
to  the  occurrence  of  a  typical  malignant  tumor  in  a  com- 
plete and  living  individual,  and  in  the  other  to  the  pro- 
duction of  a  pair  of  healthy  twins.  In  the  light  of  this 
fact  I  would  remind  the  reader  of  the  statement  already 
made,  that,  according  to  Dr.  Beard's  theory,  the  death 
inflicted  by  cancer  is  really  a  fratricide. 

In  this  connection  I  must  mention  the  very  strange 
group  of  tumors  which  are  described  as  dermoid  tumors, 
owing  to  the  fact  that  they  always  contain  skin  or  mucous 
membrane,  occurring  where  neither  skin  nor  mucous 
membrane  has  any  business  to  be.  Many  dermoids  are 
apt  to  be  confused  with  so-called  teratomas,  or  tumors 
consisting  of  a  monstrosity.  "A  teratoma,"  says  Mr. 
Bland  Sutton,  in  his  article,  "Tumors,"  in  the  Encyclo- 
pcvdia  Medica,  "is  an  irregular,  conglomerate  mass  con- 
taining the  tissues  and  segments  of  viscera  of  a  sup- 
pressed foetus  attached  to  an  otherwise  normal  individ- 
ual." Now  certain  dermoids  seem  undoubtedly  to  be 
due  to  the  inclusion  of  portions  of  skin  below  the  skin- 
surface  and  their  development  there.  The  importance 
of  these  is  small,  for  we  know  that  sometimes  the  acci- 
dental puncture  of  the  skin,  pushing  a  portion  of  it  below 
the  surface,  may  give  rise  to  a  small  tumor.  This  is 
merely  the  growth  of  misplaced  skin,  and  has  nothing 
to  do  with  our  subject.  Moles  also  are  really  dermoids, 
but  as  they  sometimes  give  rise  to  malignant  tumors, 
and  as  the  tissue  underlying  a  mole  has  a  structure  re- 
sembling that  of  certain  malignant  tumors,  they  are  of 


46  THE  CONQUEST  OF  CANCER 

more  importance;  but  here  I  wish  especially  to  refer  to 
the  most  common  variety  of  dermoid  tumors,  which  are 
called  "ovarian  dermoids."  These  are  cystic,  or  more 
or  less  hollow,  tumors,  which  occur  very  frequently  in 
the  ovary — that  is,  in  the  proper  germ-cell  tissue — and 
contain  such  things  as  mucous  membrane,  skin,  hair, 
teeth,  horn  and  bone.  Fine  growths  of  hair  and  remark- 
ably perfect  teeth  are  not  infrequently  found  in  them. 
It  is  difficult  to  believe  that  there  can  be  any  fundamental 
distinction  between  a  teratoma — a  sort  of  jumble  of  the 
organs  and  tissues  that  should  have  made  an  individual 
— and  an  ovarian  dermoid  that  contains  not  merely  skin 
and  structures  derived  from,  or  cognate  with,  skin,  such 
as  teeth  and  hair,  but  also  bone,  which  has  a  totally  differ- 
ent origin.  I  believe  that  the  key  to  the  whole  of  this 
hitherto  uncharted  area  of  pathology  has  now  been  placed 
in  our  hands.  It  is  especially  the  recent  knowledge  of 
this  subject  that  bears  upon  the  general  question  before 
us.  In  Mr.  Bland  Sutton's  admirable  article,  for  instance, 
which  was  published  in  1902,  there  is  no  reference  at  all 
to  the  possibility  that  a  teratoma — this  jumble  of  a  second 
individual — may  ever  be  malignant.  But  now  the  exist- 
ence of  malignant  teratomas  is  well  recognized,  and  evi- 
dently it  is  of  the  utmost  importance  in  still  further 
filling  up  the  interval,  which  has  now  been  completely 
filled  up,  between  the  malignant  ovarian  tumor  at  the  one 
extreme,  and  the  production  of  identical  twins  at  the 
other. 

Lastly,  I  would  observe  that  the  commonest  of  all 
tumors  are  the  cystic  tumors  of  the  ovary,  and  that  all 
stages  have  been  observed  between  them  and  malignant 
tumors  of  this  organ.     I  believe  that  we  shall  yet  treat 


CANCER  AND  TROPHOBLAST  47 

"cystic  ovary"  by  means  of  trypsin  and  amylopsin,  or 
other  ferments. 

Though  Dr.  Beard  and  all  his  works  were  rigorously 
ignored  at  the  meetings  of  the  British  Medical  Associa- 
tion both  in  1906  and  1907,  at  the  latter  meeting  Professor 
Swayne,  of  Bristol,  read  a  paper  on  Chorio-epithelioma, 
which  is  of  interest  to  us  here.  (British  Medical  Journal, 
Aug.  24,  1907,  p.  440.)  The  author  remarks  that,  in 
studying  the  ovum  of  the  hedgehog,  Hubrecht  "showed 
the  development  of  the  'trophoblast'^  by  proliferation  and 
thickening  of  the  outer  layer  of  the  primitive  epiblast, 
with,  around  the  trophoblast,  coincident  destruction  of 
maternal  tissues,  which  latter  was  of  a  temporary  nature 
only,  equilibrium  between  the  edacious  properties  of  the 
trophoblast  and  the  resistance  of  the  maternal  tissues 
being  eventually  obtained;  the  Peters^  ovum  exhibited 
similar  processes." 

Here  it  may  be  noted  that  Dr.  Beard's  explanation  of 
the  arrest  of  the  growth  of  the  trophoblast  is  totally 
ignored  and  an  explanation  offered  which  is  exactly  sim- 
ilar to  that  of  Moliere's  physician,  who  "explained"  the 
hypnotic  power  of  opium  as  due  to  its  vis  dormitiva. 

The  author  notes  the  work  of  another  observer,  who 
showed  that  the  trophoblast,  even  in  normal  conception, 
"manifests  up  to  a  certain  point  of  the  development  of 
the  ovum  characteristics  simulating  those  of  malignant 
growth,  which  are  lost  when  the  resistance  of  the  ma- 

"' What  is  this  'trophoblast'  ?  Has  any  one  besides  Dr.  Beard 
seen  it?"  I  have  been  asked.  Doctors  are  not  learned  in  embry- 
ology, and  they  are  little  to  blame  therefor ;  but  the  fact  should 
deter  them  from  hasty  criticism  of  embryological  reasoning. 

*A  human  ovum. 


48  THE  CONQUEST  OF  CANCER 

ternal  tissues  is  able  to  overpower  the  edacious  (i.e. 
digestive)  properies  of  the  trophoblast." 

The  subsequent  paragraphs  of  this  paper  show  how 
nearly  it  is  possible  to  approach  the  trophoblastic  theory 
of  malignant  tumors  without  mentioning  or  recognizing 
it.  The  author  quotes  several  recorded  cases  in  which 
growths  "apparently  identical"  with  chorio-epithelioma 
— I.e.  trophoblast  the  growth  of  which  is  abnormally  per- 
mitted to  continue — have  occurred  not  only  in  cases 
where  conception  had  not  occurred  at  all,  but  also  in 
males !  For  instance,  Andrews  found  trophoblastic  tissue 
in  a  sarcoma  of  the  femur,  or  thigh-bone.  Schlangen- 
haufer  in  1902  reported  two  cases  in  males,  one  of  a 
sarcoma  of  the  testicle,  with  secondary  growths,  "the 
tumors  having  the  structure  of  chorio-epithelioma," 
while  in  the  other  the  structure  reproduced  not  only  the 
trophoblast  itself,  but  even  certain  of  the  tissues  which 
lie  immediately  underneath  it. 

In  the  ensuing  discussion,  Prof.  Strassman,  of  Berlin, 
commented  upon  the  occurrence  of  these  tumors  in  males, 
and  suggested  that  "a  new  view  of  the  etiology  (causa- 
tion) of  these  tumors  will  be  discovered."  But  no  one 
alluded  to  the  view  advanced  by  Dr.  Beard  nearly  three 
years  before. 

The  critical  student  may  perhaps  consider  that  when 
epithelioma  of  the  chorion  is  found  to  occur  m  the 
male,  the  slavery  in  which  we  are  held  by  language  has 
reached  intolerable  limits.  I  refer  to  this  paper  because 
it  instances  the  fashion  in  which  Dr.  Beard's  work  is 
ignored  by  physicians,  and  because  of  its  relevance  to 
the  discussion,  in  another  chapter,  of  the  manner  in  which 
the  microscopic  study  of  cancer  has  become  a  fetish :  so 
that  when  a  structure  resembling  that  of  trophoblast  is 


CANCER  AND  TROPHOBLAST  49 

found  in  a  male,  it  is  labelled  chorio-epithelioma,  while 
the  obvious  processes  of  thought  are  arrested  by  the  spec- 
tacle. If  chorio-epithelioma — that  is  to  say,  a  tumor 
consisting  of  trophoblast — is  admitted  to  occur  in  the 
male,  and  to  constitute  certain  tumors  of  bone,  it  will 
seem  to  most  people  that  the  trophoblastic  theory  of 
malignant  growths  requires  no  further  admission.  For 
the  very  inaccurate  phrase,  chorio-epithelioma,  let  us  sub- 
stitute a  correct  one,  trophoblastoma,  not  because  names 
are  things  but  because  incorrect  naming  prejudices  think- 
ing. Trophoblastic  tissue,  then,  has  been  found  to  con- 
stitute malignant  growths  in  the  male ;  this  fact  is  familiar 
to  all  students  of  malignant  diseases :  and  can  be  stated 
in  a  discussion  amongst  experts  without  allusion  to  the 
theory  of  Dr.  Beard. 

I  submit  the  self-evident  proposition  that  the  admitted 
occurrence  of  tissue  obviously  trophoblastic  in  so-called 
sarcoma  of  bone,  and  in  the  male,  is  the  absolute  con- 
firmation of  Dr.  Beard's  theory  so  far  as  these  malignant 
tumors  were  concerned;  and  most  forcibly  suggests  the 
likelihood  that  other  malignant  tumors  are  really  of  sim- 
ilar nature.  As  to  cases  of  chorio-epithelioma,  or,  rather, 
trophoblastoma,  arising  in  the  testicle,  i.e.  in  the  germ- 
cell  tissue  of  the  male,  it  is  obvious  that  here  is  further 
evidence  of  Dr.  Beard's  views. 


CHAPTER  V 


THE   PANCREAS 


The  pancreas  is  a  gland  several  inches  long,  which  lies 
in  the  upper  and  back  part  of  the  abdomen,  being 
stretched  right  across  the  body.  It  is  usually  described 
as  having  a  head  which  is  placed  at  the  right  and  a  tail 
which  reaches  far  round  to  the  left.  The  general  appear- 
ance of  the  gland  is  not  inaccurately  suggested  by  the 
sweetbread  which  constitutes  a  table  delicacy.  It  ap- 
pears, however,  that  all  sweetbreads  provided  by  the 
butcher  are  not  pancreas,  but  that  this  popular  name  is 
applied  indifferently  both  to  the  pancreas  and  to  another 
edible  gland  which  is  found  in  the  upper  part  of  the 
chest,  and  is  called  the  thymus.  There  passes  from  the 
pancreas  a  duct  or  tube  which  can,  indeed,  be  traced 
throughout  the  whole  length  of  the  gland,  gradually  be- 
coming larger  as  it  passes  from  the  tail  to  the  head.  This 
duct  conveys  the  secretion  of  the  pancreas  to  the  bowel 
only  a  very  few  inches  below  the  stomach,  so  that  when 
the  contents  of  that  organ  are  passed  on  they  are 
promptly  subjected  to  the  action  of  the  pancreatic  juice. 

Essentially,  of  course,  the  pancreas  is  a  collection  of 
living  cells,  and  these  are  of  a  highly  characteristic  kind. 
They  are  evidently  secreting  cells,  and  if  they  are  exam- 
ined in  the  absurdly  so-called  "resting  stage" — that  is  to 
say,  the  stage  during  which  they  are  doing  their  work — 
they  are  found  to  be  manufacturing  within  them  a  great 

50 


THE  PANCREAS  51 

mass  of  tiny  grains  which  can  be  very  distinctly  seen. 
If  now  the  acid  contents  of  the  stomach  enter  the  bowel, 
these  grains  disappear,  while  at.  the  same  time  a  fluid 
secretion  is  poured  through  the  duct  of  the  gland  into 
the  bowel  where  it  is  required.  Let  us  then  consider  the 
composition  of  this  secretion^  and  let  us  do  so  in  the  light 
of  the  most  recent  knowledge.  The  older  mode  of  state- 
ment, and  one  to  which  there  is  no  serious  objection  for 
some  purposes,  is  that  the  pancreas  produces  a  secretion 
which  contains,  apart  from  unimportant  substances,  cer- 
tain ferments — amongst  them  being  one  which  digests 
proteids  or  albumins  and  is  called  trypsin,  another  which 
digests  starchy  matters  and  is  called  amylopsin,  and  a 
third  which  digests  fat  and  is  called  steapsin.  But  let 
us  first  consider  the  case  of  the  trypsin,  which  has  been 
very  exhaustively  studied. 

It  is  perfectly  evident  that  if  trypsin  is  to  be  found  in 
the  pancreas  gland,  and  if  trypsin  prevents  the  growth 
of  cancer,  cancer  of  the  pancreas  should  be  unknown. 
On  the  contrary,  this  is  a  very  well  recognized  site  of 
cancer.  This  argument  has  been  urged,  of  course,  against 
Dr.  Beard's  theory,  and  since  it  really  looks  like  a  valid 
argument,  it  has  occupied  a  practically  unique  place  in  the 
controversy — if  controversy  it  can  be  called.  Unlike 
mere  abuse  or  misstatement,  this  requires  an  answer. 

Now  the  fact  of  the  matter  is,  as  has  been  known  for 
some  years,  that  the  living  pancreas  never  contains  any 
trypsin.  I  may  quote,  for  instance,  from  the  article  on 
"Nutrition"  in  the  current  edition  of  the  Encyclopcsdia 
Britannica  (vol.  xvii,  p.  674),  and  thereafter  we  shall 
see  that  even  the  clear  statements  which  were  there  made 
as  long  ago  as  1884  fall  short  of  the  whole  truth.  The 
writer  says : 


52  THE  CONQUEST  OF  CANCER 

"The  pancreas,  when  perfectly  fresh  and  just  removed 
from  the  3^et  warm  body  of  an  animal  which  is  killed,,  does 
not  contain,  ready  formed,  all  ferments  which  will  in  the 
sequel  be  referred  to  as  characterizing  the  pancreatic 
juice.  If  we  treat  the  gland,  for  instance,  with  glycerin, 
which  possesses  the  power  of  extracting  and  dissolving 
all  the  ferments,  we  fail  to  obtain  a  solution  which  pos- 
sesses the  power  of  digesting  proteids ;  but,  instead,  we 
find  a  substance  in  the  solution  from  which,  by  the  addi- 
tion of  a  little  acetic  acid,  the  proteolytic  ferment  may  be 
formed.  The  cells  of  the  pancreas  thus  elaborate  a  sub- 
stance which  is  the  antecedent  of  the  proteolytic  ferment, 
and  which  yields  it  when  it  passes  into  the  pancreatic 
ducts :  it  is  customary  to  speak  of  this  body  as  zymogen, 
or  ferment-former,  because  it  gives  rise  to  one  of  the 
chief  enzymes  or  ferments  of  the  juice." 

This  was  written  nearly  a  quarter  of  a  century  ago, 
and  is  in  itself  a  quite  sufhcient  answer  to  the  almost  soli- 
tary argument  that  has  emerged  from  the  opponents  of 
the  trophoblast  theory;  but,  as  I  say,  it  by  no  means 
states  the  whole  truth,  which  has  been  quite  well  known 
for  some  time.  As  in  the  case  of  almost  all  the  body  fer- 
ments, trypsin  has  its  precursor,  which  is  called  trypsin- 
ogen,  and  which  was  discovered  by  Heidenhain.  This 
substance,  and  this  alone,  is  found  in  the  pancreas,  and 
it  has  no  action  whatever  upon  proteids.  If  therefore  an 
aberrant  germ-cell  had  found  its  way  into  the  pancreas, 
and  some  cause  led  to  its  development  into  trophoblast — 
"cancer  of  the  head  of  the  pancreas" — it  would  have  no 
more  difficulties  there  than  anywhere  else.  On  the  other 
hand,  the  development  of  a  tumor  in  the  upper  part  of 
the  intestine  would  have  to  reckon  with  trypsin:  and 
tumors  there  are  excessively  rare. 


THE  PANCREAS  53 

The  great  Russian  physiologist,  Pawlow,  has  proved 
that  whilst  the  pancreatic  secretion,  as  it  leaves  the  pan- 
creas, is  without  any  appreciable  action  upon  proteids, 
it  very  rapidly  becomes  active  when  a  small  quantity  of 
the  intestinal  juice  is  added  to  it.  There  has  indeed  been 
discovered  in  the  intestinal  juice  a  body  which,  by  some 
means  or  other,  converts  the  inactive  trypsinogen  into 
active  trypsin.  This  body  was  called  enterokinase  by 
Pawlow,  and  he  regarded  it  as  being  itself  a  ferment. 
Some  French  observers  have  disputed  this,  but  according 
to  Professors  Bayliss  and  Starling,  and  Dr.  J.  M.  Hamill 
more  recently,  of  University  College,  London,  Pawlow 
was  right,  and  there  seems  to  be  no  doubt  that  the  trypsin 
which  daily  does  invaluable  digestive  work  within  the 
bowel  of  each  of  us  is  itself  a  product  of  the  fermentation 
of  trypsinogen  by  the  intestinal  ferment  enterokinase. 
It  is  well  here  to  recall  also  the  fact  which  was  actually 
observed  by  Kiihne,^  that  glycerin  extracts  of  the  fresh 
pancreas  are  of  little  or  no  digestive  capacity,  and  require 
the  influence  of  such  a  substance  as  dilute  acetic  acid  in 
order  to  develop  trypsin  within  them.  This  acetic  acid 
has  constituted  a  grave  nuisance  during  the  whole  of  the 
earlier  stages  of  the  pancreatic  treatment  of  cancer,  since 
it  has  occurred  in  most  of  the  injections  that  have  been 
put  upon  the  market,  and  since,  as  might  well  be  ex- 
pected, it  causes  much  pain  when  introduced  under  the 
skin.  These  facts  regarding  the  secretion  of  the  pan- 
creas are  of  far  greater  moment,  however,  than  any  ques- 
tion of  painful  injections,  for  they  bear  immediately  upon 
the  whole  theory  of  the  relation  between  the  pancreas  and 
cancer. 

^Trypsin  was  discovered  by  Corvisart  in  1858,  and  named  by 
Kiihne  in  1876. 


5Ji  THE  CONQUEST  OF  CANCER 

Some  time  ago  it  was  shown  that  arrest  of  all  the 
activities  of  the  pancreas  leads  to  the  occurrence  of  the 
disease  called  diabetes,  and  some  authors  have  supposed, 
though  this  is  doubtful,  that  certain  peculiar  "islands"  of 
cells  found  here  and  there  in  the  gland  produce  a  special 
substance  which  is  absorbed  into  the  blood,  and  by  its 
continuous  presence  there  prevents  the  occurrence  of 
diabetes.  If  we  ignore  the  recently  challenged  assertion 
that  these  special  islands  of  cells  have  this  special  func- 
tion, then  the  theory  must  undoubtedly  stand  as  fact. 
There  can  be  no  question  that  the  pancreas  or  some  part 
of  it  does  produce  an  "internal  secretion,"  as  the  phrase 
goes,  which  serves  to  insure  the  proper  performance  of 
the  bodily  chemistry,  a  disturbance  of  w^hich  constitutes 
the  disease  diabetes. 

But  there  is  no  definite  reason  to  suppose  that  there 
is  any  parallel  between  the  case  of  diabetes  and  the  case 
of  cancer  in  this  regard.  The  product  of  the  pancreas  is 
trypsinogen,  which  is  normally  converted  into  trypsin  in 
the  bowel  and  does  its  work  there — which  is  to  complete 
the  proteid  digestion  commonly  begun  in  the  stomach. 
It  is  not  yet  known  whether  the  trypsin  so  formed  ever 
returns  as  trypsin  to  the  body.  Probably  in  the  course 
of  the  various  decompositions  that  occur  in  the  ordinary 
civilized  man's  bowel  it  is  destroyed,  but  it  is  quite  con- 
ceivable that  this  trypsin  might  escape  destruction,  and 
might  actually  be  absorbed  by  the  absorbent  cells  of  the 
bowel,  just  as  the  nutritive  products  of  the  digestion  of 
the  food  are  absorbed.  If  this  were  so,  the  trypsin  thus 
gained  by  the  blood  would  have  an  antagonistic  effect 
upon  any  trophoblastic  or  cancerous  tissue  with  which 
it  came  in  contact,  until  it  was  disposed  of,  probably  by 
the  kidnevs.    As  we  shall  see,  enormous  doses  of  active 


THE  PANCREAS  55 

trypsin  have  been  injected,  in  Warsaw,  under  the  skin 
of  animals.  These  were  disposed  of  by  the  kidneys,  the 
activity  of  the  ferment  being  still  retained — but  the  ani- 
mals displayed  no  symptoms  of  any  kind  whatsoever. 
These  experiments  have  been  repeated  and  extended 
lately,  with  similar  results,  by  Pinkuss  and  Pinkus  in 
Berlin. 

This  last  is  an  absolutely  cardinal  fact,  and  must  be 
insisted  upon  in  our  study  of  the  pancreas.  I  quote,  for 
instance,  from  the  article  on  "Therapeutics,"  written  by 
a  highly  distinguished  physician  for  the  tenth  edition  of 
the  Eycyclopcedia  Britannica  (vol.  xxxiii,  p.  273)  :  "The 
secretion  of  some  digestive  glands  would  prove  poisonous 
if  absorbed  unchanged,  e.g.  the  trypsin  of  the  pancreas 
digests  albuminous  bodies  in  neutral  or  alcoholic  solu- 
tion, and  if  the  whole  of  that  which  is  secreted  in  the 
pancreas,  for  the  digestion  of  meat  in  the  intestine,  were 
absorbed  unchanged  into  the  circulation,  it  would  digest 
the  body  itself,  and  quickly  cause  death."  This  dogmatic 
statement  is  wholly  untrue.  On  the  contrary,  it  may  now 
be  positively  asserted  that  trypsin  has  no  action  upon  the 
cells  of  the  normal  body.  Thus,  when  enormous  doses 
of  it  are  injected  under  the  skin,  they  affect  in  no  way 
whatever  any  of  the  normal  tissues  of  the  body,  and  if 
the  body  holds  none  but  normal  tissues,  no  results  of  any 
kind  are  to  be  observed;  but  if  there  be  growing  in  it 
what  we  call  cancer  or  trophoblast,  that  is  poisoned  by 
the  ferment. 

Whilst,  on  the  one  hand,  we  know  definitely  that  the  liv- 
ing pancreas  never  produces  or  contains  any  trypsin,  and, 
therefore,  cannot  pass  it  into  the  blood  directly,  we  know, 
on  the  other  hand,  that  the  trypsinogen  which  it  pours 
into  the  bowel,  and  which  is  there  converted  into  trypsin, 


56  THE  CONQUEST  OF  CANCER 

has  its  own  work  to  do ;  and  we  do  not  yet  know  whether 
any  of  it  ever  gets  into  the  blood.  In  the  present  state 
of  our  knowledge,  therefore,  it  is  very  necessary  that  we 
should  ascertain  whether  the  blood  of  an  individual  whose 
pancreas  is  in  perfect  health  and  full  activity  ever  con- 
tains any  trace  of  trypsin. 

So  much  for  the  later  and  longer  period  of  the  history 
of  the  pancreas ;  let  us  now  consider  its  origin  and  earlier 
history.  The  pancreas  arises  from  the  innermost  layer 
of  the  embryo  at  a  very  early  stage  in  its  history.  As 
Dr.  Beard  showed  in  1896  for  certain  of  the  fishes,  the 
pancreas  is  formed  and  begins  to  function  at  the  "critical 
period."  Said  Dr.  Beard  {On  Certain  Problems  of 
Vertebrate  Embryology,  1899)  :  "It  has  been  recorded 
that  the  pancreas  in  Scyllinm  begins  to  enter  upon  its 
functions  with  the  introduction  of  yolk  into  the  gut  at 
the  critical  period.  It  is  probable  that  the  critical  period 
marks  the  time  in  all  vertebrates  when  this  secretory 
structure  first  commences  its  functions."  The  activity 
of  the  pancreas  is  necessary  for  the  digestion  of  the  yolk, 
which  at  this  period  is  drawn  into  the  gut,  "where,  during- 
the  rest  of  the  development  within  the  egg  case,  and  for 
some  time  afterwards,  it  serves  for  the  nourishment  of 
the  young  fish." 

The  positive  evidence  of  pancreatic  activity  is  obtained 
by  the  microscope,  for  it  is  at  this  period  first  that,  when 
the  cells  of  the  gland  were  examined,  they  were  found  by 
Dr.  Beard  to  contain  the  tiny  granules  which  yield  its 
digestive  secretion.  At  the  International  Physiological 
Congress,  held  at  Heidelberg,  August,  1907,  Barbera  re- 
ported that  he  had  examined  the  foetuses  of  dogs  in 
various  stages,  and  found  trypsinogen  produced  by  the 
pancreas  and  enterokinase  by  the  bowel — the  amount  pro- 


THE  PANCREAS  57 

duced  increasing  witli  the  development  of  the  organs. 
We  may  note  again  that  there  is  no  digestion  of  food 
for  the  trypsin  to  accomplish  in  man;  but  there  is  diges- 
tion of  trophoblast. 

In  the  case  of  man,  it  is  quite  certain  that  the  seventh 
week  of  development  corresponds  to  the  critical  stage. 
It  is  at  this  stage  that  in  man  and  the  higher  mammals 
generally,  a  change  of  the  mode  of  nutrition  is  brought 
about  by  the  suppression  of  the  trophoblastic  tissue.  This 
tissue  has  been  variously  named,  and  is  most  commonly 
known  to  physicians  as  the  'syncytium"  of  the  chorion. 
Prof.  Hubrecht  in  1899  gave  it  the  name  of  trophoblast. 

Now  in  the  light  of  what  we  have  already  said  regard- 
ing the  way  in  which  the  pancreas  does  its  work,  those 
who  care  to  go  closely  into  this  question  will  be  inclined 
to  ask  how  it  may  be  supposed  that  the  substances  pro- 
duced by  the  pancreas  in  its  earliest  stages  can  reach  the 
trophoblast  in  such  a  way  as  to  cause  its  digestion.  It 
is  now  demonstrated  that  the  foetal  pancreas  sends  its 
trypsinogen  and  other  ferments  or  their  antecedents  into 
the  empty  bowel ;  whence,  in  foetal  life,  at  any  rate,  they 
may  be  readily  absorbed  into  the  blood.  The  trypsin 
which  reached  its  perfect  state  in  the  bowel  will  pass 
through  the  kidneys  and  thence,  as  the  embryologist  will 
understand,  to  the  allantois,  or  foetal  bladder,  in  parallel 
with  the  case  of  the  dogs  observed  by  Pinkus.  Having 
once  travelled  so  far,  the  trypsin  must  obtain  ready  access 
to  the  trophoblastic  tissue  within  which  the  allantois  is 
developing. 

If  these  considerations  are  correct,  we  should  expect 
very  marked  and  serious  consequences  to  ensue  in  cases 
where,  for  any  reason,  the  pancreas  does  not  develop. 
Now  this  sometimes  happens,  as  we  have  seen.     There 


58  THE  CONQUEST  OF  CANCER 

are  known  cases  in  which  the  embryo  undergoes  defect- 
ive development  so  that  its  pancreas  is  either  never 
formed,  or  fails  to  perform  its  function.  In  such  cases 
there  is  nothing  to  arrest  the  indefinite  growth  and  mul- 
tiplication of  the  cells  of  the  trophoblast,  and  these  ac- 
cordingly go  on  multiplying.  The  consequent  deadly 
form  of  malignant  tumor  is  only  too  well  known,  and  is 
commonly  called  chorio-epithelioma.  I  quote  from  Dr. 
Beard  -.^ 

"In  human  gestation,  if  at  the  critical  period  the 
embryo  be  wanting  or  very  abnormal  [a  very  abnormal 
human  embryo  can  only  persist  as  one  of  identical  twins], 
the  phenomena  of  the  critical  period  are  lacking,  and  the 
normal  trophoblast,  which  always  begins  its  life  by 
eroding  the  uterine  epithelium  and  wall,  may  go  on  with 
this  process,  exhibit  indefinite  powers  of  growth,  and  eat 
its  way  through  uterus  and  other  organs,  finally  blocking 
the  lungs  and  brain  of  the  mother.  This  is  chorio-epithe- 
lioma, recognized  to  be  a  form  of  cancer  by  Prof.  F. 
Marchand  in  1895.  This  is  without  doubt  the  most  deadly 
form  of  cancer.  Here,  the  sexual  generation  being  un- 
able to  suppress  the  asexual  one,  or  trophoblast,  the  latter 
exhibits  the  characteristics  of  asexual  generations,  the 
powers  of  indefinite  growth  and  increase." 

'"The  Interlude  of  Cancer,"  New  York  Medical  Record,  Feb- 
ruary 2,  1907. 


CHAPTER  VI 

THE  EVOLUTION  OF  THE  DISCOVERY 

In  the  preceding  chapters  I  have  endeavored  to  trace 
in  logical  fashion  the  various  parts  of  the  theory  upon 
which  the  new  treatment  of  cancer  is  based.  In  the 
present  chapter  it  is  necessary  very  briefly  to  refer  to 
the  stages  of  Dr.  Beard's  work,  especially  because  his 
right  to  priority  has  been  questioned,  directly  or  indi- 
rectly, on  one  point  or  another,  both  in  Great  Britain  and 
in  Germany. 

Dr.  Beard's  published  works  show  that,  so  far  back  as 
1902,  the  work  which  he  began  in  1888  had  led  him  to 
enunciate  the  conclusion  that  cancer  is  an  irresponsible 
trophoblast  {Lancet,  June  21,  1902,  p.  1758). 

The  problem  as  it  then  presented  itself  to  Dr.  Beard 
is  thus  expressed  by  him :  "It  was  that  in  every  normal 
development  the  trophoblast,  which  in  the  absence  of  a 
completed  embryo  might  become  a  malignant  tumor, 
chorio-epithelioma,  was  invariably  suppressed  and  degen- 
erated. The  task  was  to  find 'out  how  this  came  about. 
For  there  appeared  to  be  good  reason  for  the  hope,  if  not 
for  the  sure  belief,  that  the  factor,  or  factors,  which 
brought  about  this  result  in  normal  development  might 
also  be  potent  when  directed  against  an  irresponsible 
trophoblast  or  cancer." 

On  December  13,  1904,  Dr.  Beard  read  a  paper  before 
the  Edinburgh  Pathological  Club.^     This  paper  consti- 

*An  abstract  of  this  was  printed  in  the  Lancet,  February  4,  1905. 

59 


60  THE  CONQUEST  OP  CANCER 

tutes  the  first  assertion  of  the  solution  of  the  cancer  prob- 
lem, and  the  first  suggestion  of  the  use  of  trypsin.  In 
this  paper  Dr.  Beard  laid  down  the  proposition  that  "The 
change  in  nutrition  initiated  at  the  critical  period  in 
vertebrate  animals,  from  fishes  to  man,  is  based  in  the 
commencing  functional  activities  of  the  pancreas.  This 
introduces  an  alkaline  digestion  by  means  of  the  pan- 
creatic juice  with  its  various  ferments.  .  .  .  Under 
the  conclusions  already  advanced  regarding  the  nature 
of  cancer  as  an  irresponsible  trophoblast,  in  consideration 
of  the  facts  regarding  the  acid  and  eroding  action  of  the 
trophoblast  and  of  carcinoma,  and  in  respect  of  the  fact 
that,  in  the  absence  of  a  completed  embryo  or  foetus  and 
its  pancreatic  secretion,  the  trophoblast  may  become  one 
of  the  most  deadly  of  malignant  tumors,  chorio-epithe- 
lioma,  it  must  be  clear  that  nature  itself  has  possibly  pro- 
vided a  remedy  for  cancer,  and  the  pernicious  [intracel- 
lular] cancerous  digestion  of  the  trophoblast,  in  the  secre- 
tion of  that  important  digestive  gland,  the  pancreas. 
.  .  .  Moreover,  it  is  very  important  to  note  that,  just 
as  cancer  is  found  everywhere  in  the  vertebrates,  just  as 
there  is  one  mode,  and  one  only,  of  vertebrate  develop- 
ment, so  the  pancreas  and  its  secretion  are  a  common 
heritage  of  vertebrate  animals.^     .    .    . 

"Practically  all  that  was  sought  after  from  my  own 
researches,  regarding  cancer,  has  now  come  to  light.' 
Embryologically,  the  problem  of  cancer  has  been  to  dis- 
cover the  antithesis  of  two  enzymes  [ferments],  and  in 
particular  to  find  out  the  enzyme  capable  of  destroying  a 
weaker  one,  and  thus  of  leading  to  the  degeneration  of  the 

'As  noted  elsewhere,  trypsinogen,  enterokinase  and  trypsin  have 
lately  been  proved  identical  in  vertebrates  generally  by  Dr.  J.  M. 
Hamill. 


EVOLUTION  OF  THE  DISCOVERY         61^ 

tumor  by  simple  atrophy.  The  whole  story  is  but  another 
example  of  that  antithetic  alternation  which  underlies  all 
the  phenomena  of  living  things.  The  solution  of  the  prob- 
lem of  the  functional  relation  of  embryo  and  trophoblast, 
how  the  latter  nourishes  itself  by  an  [intracellular]  acid 
peptic  digestion  and  degenerates  slowly  by  a  pancreatic 
digestion,  becomes  at  the  same  time  the  embryological,  if 
not  the  medical,  resolution  of  the  problems  of  malignant 
neoplasms,  as  well  as  of  chorio-epithelioma.  As  an  em- 
bryologist  who  is  not  a  physician  or  surgeon  my  task  is 
ended.  The  further  applications  of  the  scientific  and 
theoretical  solutions  of  the  problem  may  safely  be  left 
in  the  hands  of  those  who  know  far  better  how  to  employ 
it.  But  they  may  not  forget  that  in  nature  the  degen- 
eration and  disappearance  of  these  asexual  structures, 
sometimes  quick,  are  often  exceedingly  slow,  though  sure. 
Not  that  it  is  likely  that  the  surgeon  has  removed  his  last 
malignant  tumor,  but  that,  as  one  of  the  results  of  the 
work  begun  more  than  sixteen  years  ago,  the  physician 
has  possibly  had  forged  for  him  a  light  and  not  dangerous 
weapon,  only  second,  if  not  equal,  in  potency  to  the 
surgeon's  knife." 

Elsewhere  we  shall  see  in  what  fashion  the  Lancet 
expressed  its  appreciation  of  the  privilege  of  printing 
this  paper,  in  which  an  unsurpassed  discovery  in  the 
realm  of  rational  therapeutics  was  first  announced. 

Only  a  few  weeks  after  Dr.  Beard's  lecture,  Dr.  Shaw 
Mackenzie  began  the  use  of  hypodermic  use  of  trypsin 
in  cancer,  and  to  him,  undoubtedly,  must  be  awarded 
the  credit  of  being  the  first  physician  to  employ  the  new 
treatment.  (For  the  date,  January,  1905,  see  Dr.  Shaw 
Mackenzie's  book.  The  Nature  and  Treatment  of  Cancer, 
p.  4.)     Dr.  Shaw  Mackenzie,  however,  bases  his  prac- 


62  THE  CONQUEST  OF  CANCER 

tice  upon  a  theory  of  his  own  regarding-  tKe  nature  of 
cancer,  and  uses  trypsin  in  the  beHef  that  there  has  been 
demonstrated  its  power  of  breaking  up  the  substance 
called  glycogen.  It  is  hardly  necessary,  however,  to  say 
that  trypsin  has  no  such  power.  There  is  no  known  fer- 
ment which  affects  both  proteids  and  carbo-hydrates,  such 
as  glycogen,  and  to  any  student  of  the  ferments  in  general 
(see  Chapter  IX)  it  is  inconceivable  that  there  should  be. 
It  is  interesting  to  go  back  a  little  further.  In  the 
Lancet  (June  21,  1902),  Dr.  Beard  had  stated  that  the 
substance  which  would  destroy  cancer  must  be  contained 
either  in  foetal  blood  or  in  the  allantoic  placenta.  In  De- 
cember, 1904,  knowing  that  cancer  occurs  lower  than 
the  mammals — or  placental  animals — ^he  could  exclude 
the  placenta;  for  the  degeneration  of  trophoblast  occurs 
in  all  the  higher  animals  and  not  the  mammals  only.  In 
that  month,  in  controversy,  Dr.  Beard  remarked  that 
"the  mammalian  embryo  solved  the  problems  of  cancer 
ages  ago."  To  see  this  phrase  in  print  was  to  suggest 
to  him  the  need  of  turning  back  to  his  early  work  on  the 
critical  period.  My  purpose  is  to  illustrate  the  condi- 
tions under  which  discoveries  are  made,  and  I  will  here 
quote  from  a  private  letter  of  Dr.  Beard  to  myself : 

"At  once,  December  8,  1904,  I  got  out  all  my  critical 
period  preparations  in  this  room,  as  well  as  my  paper  on 
the  critical  period.  I  looked  at  some  of  the  slides  of  post- 
critical  embryos,  especially  at  the  digestion  of  yolk,  then  at 
my  paper,  and  saw  at  once  that  I  had  neglected  to  lay  stress, 
as  a  character  of  the  critical  period,  on  the  commencing 
functional  activities  of  the  PANCREAS-gland.  So  the  problem 
was  solved  so  far.  The  other  thing  is  a  later  story.  At 
once  I  saw  there  must  be  an  antithesis  of  ferments,  but  was 
not  aware  whether  any  ferment  had  been  described  in  the 
cancers.  But  I  postulated  the  existence  of  an  intracellular 
,ierment  therein,  acting  in  slightly  acid  medium.     I  set  about 


EVOLUTION  OF  THE  DISCOVERY         63 

getting  chick  blastcxlerms,  as  I  couH  get  no  fresE  cancers. 
Then  I  recalled  that  Hartog'  had  already  described  such  a 
ferment  in  chick  blastoderm  of  three  days.  In  the  meantime 
I  had  tried  to  get  out  from  the  Univ.  library  Hoppe-Seyler's 
big  book  on  physiological  chemistry.  It  was  out,  so  I  had 
to  wait  for  it.  It  came  about  four  days  before  my  lecture 
in  Liverpool  was  due.  In  it  I  found  the  reference  to  Petry's 
paper.  Next  day,  January  i8,  1905,  after  lecture  I  went 
and  got  out  the  vol.  of  the  Zeitschr.  f.  Physiol.  Chemie  with 
Petry's  paper.  Opened  it  in  the  library  and  read  it  in  going 
along  the  Quad,  to  my  room.  Then  it  was  you  might  have 
heard  my  heart  thump.  All  was  exactly  as  I  had  foreseen. 
The  cancers  had  a  ferment  acting  in  acid  medium,  and  as 
they  had  no  ducts,  it  was  intracellular,  its  intracellular  nature 
being  afterward  stated  by  Blumenthal." 

This  letter  was  not  sent  me  for  publication,  but  I  have 
taken  the  liberty  of  putting  it  on  record  for  its  personal 
and  general  interest. 

*The  reference  is  to  Professor  Hartog's  paper,  "Some  Problems 
of  Reproduction,"  Quarterly  Journal  of  Microscopical  Science, 
1904,  p.  583. 


CHAPTER  VII 

the  immediate  causes  of  cancer 
The  Predisposing  Causes 

In  the  study  of  the  causation  of  disease,  we  very  com- 
monly find  it  convenient  to  divide  such  causes  as  we  can 
recognize  into  two  categories — the  predisposing  and  the 
exciting.  Thus,  for  instance,  in  the  case  of  the  most 
fatal  disease  of  all,  consumption,  we  say  that  the  pre- 
disposing causes  are  such  things  as  long  exposure  to  foul 
air,  while  the  invariable  and  essential  exciting  cause  is 
the  tubercle  bacillus.  If  we  apply  this  terminology  to 
cancer  as  we  now  conceive  it,  we  discover  that  in  this 
case,  according  to  the  theory  of  Dr.  Beard,  the  predis- 
posing cause  is  a  constant  thing,  the  presence  of  an 
aberrant  germ-cell  having  definite  possibilities,  while  the 
exciting  cause  or  causes  are  not  elucidated  by  his  work. 
In  point  of  fact,  though  students  of  disease  commonly 
accept  these  terms,  there  is  no  philosophic  defense  for 
them.  In  this  complex  universe  causation  is  complex, 
and  there  is  no  one  cause  of  any  one  thing.  The  univer- 
sal past  is  the  cause  of  any  one  event.  Still  we  may 
take  it  that  the  presence  of  an  aberrant  germ-cell  of  a 
particular  kind  is  the  predisposing  cause  of  any  malignant 
growth,  and  this  preliminary  proposition  requires  brief 
comment. 

It  is  the  observed  fact  of  the  development  of  certain 

64 


IMMEDIATE  CAUSES  OF  CANCER        65 

of  the  lower  animals,  as  discovered  by  Dr.  Beard,  not 
only  that  aberrant  g-erm-cells  can  be  detected  in  various 
parts  of  the  body,  but  also  that  they  are  most  commonly 
seen  in  those  sites — such,  for  instance,  as  the  mouth  and 
the  stomach — in  which  human  cancer  is  most  commonly 
known  to  arise.  This  fact  in  itself  lends  support  to  Dr. 
Beard's  theory,  in  which  we  recognize,  so  far  as  this  part 
of  it  is  concerned,  a  new  form  of  the  view  long  enter- 
tained in  various  forms  by  many  students,  that  the  cells 
from  which  a  cancer  arises  have  always  been  from  the 
first  essentially  different  to  the  other  cells  amongst  which 
they  lie.  The  theory  of  Cohnheim,  for  instance,  asserted 
that  cancer  arose  from  cells  which  properly  belonged  to 
one  layer  of  the  embryo,  but  had  lost  their  way  and  be- 
come lodged  in  another  layer.  Various  surgeons  also, 
without  any  more  specific  statement,  have  inclined  to  the 
view  that  some  local  peculiarity  is  always  necessary  for 
the  excitation  of  cancerous  growth. 

Directly  we  consider  the  causes  which  are  known  to 
excite  cancer,  we  find  evidence  which  seems  to  support 
this  view.  It  is  known,  for  instance,  and  is  disputed 
by  no  one,  that  cancer  on  the  edge  of  the  tongue  can 
often  be  traced,  quite  definitely,  to  the  irritation  of  a 
jagged  tooth,  and  cancer  of  the  lip  to  that  caused  by 
smoking  a  hot  clay  pipe.  But  to  take  the  first  instance, 
do  we  sufficiently  recognize  a  fact  which  has  always  puz- 
zled myself,  and  which  no  surgeon,  I  think,  would  ques- 
tion, that  for  every  one  case  of  cancer  of  the  tongue 
resulting  from  the  irritation  caused  by  a  jagged  tooth, 
we  should  be  able  to  find  scores  or  hundreds  of  cases  in 
which  similar  irritation  produced  nothing  but  a  simple 
ulcer,  which  rapidly  healed  when  the  cause  was  removed? 
Or  again,  to  take  the  case  of  cancer  of  the  lip,  if  every 


66  THE  CONQUEST  OF  CANCER 

one  who  smoked  a  clay  pipe  doomed  himself  to  cancer, 
the  fact  would  be  familiar,  and  the  habit  would  have  been 
abandoned  long  ago.  But  similar  causes  do  not  produce 
similar  effects  in  this  instance — which  is  to  say,  of  course, 
that  these  causes  are  not  all  the  causes.  Of  a  hundred 
smokers  one  will  contract  cancer  and  the  others  will  con- 
tinue to  smoke  with  impunity.  Something  is  present  in 
him,  or  lacking  in  them,  which  determines  the  difference. 
These  facts,  which  might  be  multiplied  indefinitely  from 
cases  of  local  irritation  in  any  part  of  the  body,  lend  very 
strong,  though  of  course  not  conclusive,  support  to  the 
theory  that  before  the  exciting  causes  of  cancer  can  be 
operative,  it  is  necessary  that  there  be  a  particular 
capacity  for  reacting  to  them  in  the  part  in  question,  and 
this  capacity  may  be  most  readily  attributed  to  the  pres- 
ence in  it  of  cells  of  a  special  kind.  The  facts  do  not 
lead  to  anything  more  definite  than  this ;  of  course,  so  far 
as  they  are  concerned,  the  cell  may  be  an  em.bryonic  cell 
or  a  germ-cell.  It  is  for  other  facts  to  determine  whether 
a  germ-cell  alone  can  be  conceived  as  giving  rise  to  the 
kind  of  tissue  which  we  recognize  in  malignant  growths. 
We  may  consider  yet  another  fact,  which  must  puzzle 
the  more  thoughtful  among  medical  students  when  they 
first  make  their  acquaintance  with  clinical  surgery.  It 
is  very  well  known  to  be  the  all  but  invariable  rule  that 
cancer  of  the  lip  is  found  in  the  lower  lip  and  not  in  the 
upper  lip.  ]\Iany  a  surgeon  who  has  operated  upon  hun- 
dreds of  cases  of  cancer  of  the  lower  lip  has  never 
seen  a  case  of  cancer  occurring  in  the  upper  lip.  Yet 
if  we  consider  the  smoker,  it  is  very  difficult  to  see  why 
this  should  be  so.  We  should  expect,  I  think,  more  often 
than  not  to  find  cancer  starting  at  opposite  places  in  the 
two  lips  simultaneously,  or  perhaps  a  little  later  in  the 


IMMEDIATE  CAUSES  OF  CANCER        67 

upper  lip.  Yet  this  simply  does  not  happen.  Would 
not  the  inference  appear  to  be  that  there  is  something 
present  in  the  lower  lip,  or  absent  in  the  upper,  which 
is  necessary  for  the  production  of  cancer?  Now  any 
one  who  will  study  the  embryology  of  the  face  and  com- 
pare the  mode  of  development  of  the  two  lips  will  readily 
believe  that  it  must  be  vastly  easier  for  an  aberrant  germ- 
cell  in  the  course  of  development  to  find  its  way  into  the 
lower  lip  than  into  the  upper  lip. 

These  considerations  are  not  to  be  ignored,  I  think. 
Yet  at  the  same  time,  and  with  all  due  deference  to  Dr. 
Beard,  it  seems  not  wholly  inconceivable  that  sometimes 
even  a  somatic  cell — ^that  is  to  say,  a  cell  of  the  body 
proper — might  undergo  such  reversion  as  to  become  not, 
perhaps,  a  true  germ-cell,  but  a  cell  capable  of  giving  rise 
to  trophoblastic  tissue.  It  would  be  absurd  to  assert 
that  this  positively  occurs,  but  it  would  be  difficult  to 
assign  any  reason  why  it  can  never  occur.  Our  igno- 
rance of  the  interior  processes  of  cell  life  is  abysmal. 
Though  we  find  characters  fundamentally  identical  in  all 
cells,  whether  a  tubercle  bacillus  or  the  brain-cells  of 
some  genius  like  Spinoza  or  Schubert  whom  that  bacillus 
destroys,  we  can  only  conjecture  as  to  the  character  of 
the  interior  processes,  which,  for  instance,  determine  the 
specific  inability  of  a  brain-cell  to  divide,  or  the  limitless 
capacity  for  multiplication  displayed  by  a  microbe.  We 
observe  certain  results,  but  we  are  utterly  unable  to  ex- 
press their  causation.  It  may  be  that  a  cell  of  the  normal 
body — that  is  to  say,  a  somatic  cell — has  forever  left  the 
high-road,  along  which  life  marches  in  its  successive 
generations.  Nowadays  we  conceive  the  individual  and 
the  cells  which  compose  him  as  transient  lateral  off-shoots 
.doomed  to  die,  and  serving  merely  as  the  host  for  the 


68  THE  CONQUEST  OF  CANXER 

deathless  Tme  of  germ-cells.  It  may  be  then  that  a 
somatic  cell  is  in  a  cul-de-sac,  yet  it  is  not  inconceivable 
that  within  such  a  cell  there  remain  potentialities  which 
were  proper  to  its  remote  cell  ancestors.  It  is  not  incon- 
ceivable that  even  a  somatic  cell,,  under  certain  conditions, 
may  give  rise  to  trophoblast.  I,  for  one,  would  not  care, 
therefore,  roundly  to  deny  that  pathologists  are  mistaken 
when,  as  sometim.es,  they  seem  to  detect  a  continuous 
and  multiple  transform.ation  of  many  cells  proper  to  a 
part,  into  cancerous  cells. 

These  questions  are  of  the  greatest  biological  interest, 
and  of  even  great  immediate  interest,  in  relation  to  the 
study  of  the  production  of  cancer.  Yet,  however  they 
be  answered,  the  answer  does  not  aftect  us  in  practice, 
if  the  tissue  of  a  cancer  or  any  malignant  growth  be 
always  trophoblastic,  however  derived ;  and,  being  tropho- 
blastic, must  necessarily  succumb  to  the  specific  poison 
of  trophoblast,  which  is  trypsin. 

A  further  question  which  we  mmst  here  consider  is 
whether  or  not  heredity  is  of  importance  in  predisposing, 
to  cancer.  This  is  an  extremely  difficult  question  to 
answer  in  a  dogmatic  fashion.  That  heredity  does  pre- 
dispose to  this  disease  is  the  general  belief  of  the  medical 
profession  and  of  pathologists.  Numerous  striking  in- 
stances in  special  families  are  on  record.  Too  much  im- 
portance must  not  be  attached  to  the  fact  that  Prof.  Karl 
Pearson,  studying  certain  statistics,  has  pronounced  them 
incapable  of  proving  that  cancer  is  inherited.  As  to 
those  statistics  his  opinion  may  be  accepted,  but  in  all 
such  cases  it  has  to  be  remembered  that  the  conclusion 
arrived  at  by  the  statistical  expert  is  of  just  so  much 
validity,  neither  more  nor  less,  as  the  actual  data  from 


IMMEDIATE  CAUSES  OF  CANCER        69 

which  the  statistics  were  compiled.  It  may  be  pointed 
out  further  that  the  theory  of  Dr.  Beard  certainly  lends 
probability  to  what  has  so  long  been  believed.  Dr.  Beard 
himself  is  quite  convinced  that  this  general  opinion  is 
correct,  and  that  there  is  such  a  thing  as  the  transmission 
of  a  predisposition  to  cancer.  Needless  to  say,  such  a 
transmission  is  capable  in  various  ways  of  agreement  with 
the  theory  in  question.  It  remains,  of  course,  to  inquire 
whether  it  depends  upon  the  inheritance  of  a  special  lia- 
bility to  wander  in  the  case  of  the  germ-cells,  or,  on  the 
other  hand,  upon  the  inheritance  of  such  bodily  condi- 
tions, whatever  they  be,  as  will  favor,  or  permit,  their 
untoward  development  in  later  years.  But,  at  any  rate, 
amongst  the  predisposing  causes  of  this  disease  we  must 
in  all  probability  reckon  with  something  which  is  capable 
of  transmission  by  heredity. 

The  inadequacy  of  our  category  of  causes  is  shown 
when  we  come  to  consider  the  case  of  the  pancreas  in 
this  relation.  Not  a  few  diseases  are  known  which  are 
due  to  the  occurrence  of  defect  in  the  working  of  some 
gland.  Instances  are  furnished  by  such  diseases  as 
cretinism  and  myxoedema,  due  to  thyroid  insufficiency ; 
Addison's  disease,  due  to  suprarenal  insufficiency ;  and 
diabetes,  due  to  pancreatic  insufficiency.  It  is  upon  the 
analogy  of  such  diseases  that  Dr.  Shaw  Mackenzie  has 
based  a  theory  of  cancer  which  states  that  the  disease  is 
due  to  failure  of  the  pancreas.  The  tendency  to  its  oc- 
currence in  later  years  suggests  that  the  pancreas  "gives 
out,"  so  to  speak,  before  the  rest  of  the  body — cancer 
follows  upon  senility  of  the  pancreas.  In  the  absence, 
so  far,  of  any  substantial  evidence  for  this  view,  and  i-n 
the  presence  of  a  host  of  facts  which  can  scarcely  be 
reconciled  with  it,  we  need  not  here  discuss  it  further. 


UO  THE  CONQUEST  OF  CANCER 

It  obtains  its  chief  interest  from  the  fact  that  Dr.  Shaw 
Mackenzie  associated  with  it  a  special  relation  between 
cancer  and  the  carbohydrate  substance  called  g-lycogen, 
and  that,  under  the  erroneous  impression  that  trypsin 
digests  glycogen,  he  advocates  the  use  of  trypsin  in  cases 
of  cancer. 

In  the  light  of  Dr.  Beard's  work,  however,  we  cer- 
tainly seem  compelled  to  seek  a  clear  answer  to  the  ques- 
tion whether  the  malignant  development  of  an  aberrant 
germ-cell  may  not  be  due,  in  some  cases  if  not  in  all,  to 
failure  on  the  part  of  a  previously  efficient  pancreas.  In 
other  words,  are  we  to  conceive  the  facts  in  some  such 
manner  as  follows.  That  any,  or  many,  or  all,  of  us  may 
possess,  in  various  parts  of  the  body,  aberrant  germTcells 
which  are  such  that  if  they  develop  at  all  they  will  develop 
into  malignant  tumors ;  that  this  development  is  normally 
prevented  by  the  activity  of  the  pancreas,  which  keeps 
the  body  sufficiently  supplied  with  trypsin  to  prevent  it; 
that  if  this  supply  fails  from  whatever  cause,  a  cancer  will 
probably  result.  These  questions  have  yet  to  be  answered. 

I  am  w^ell  prepared  to  believe  that  the  question  of  the 
absorption  of  trypsin  from  the  bowel  may  possibly  yet 
prove  itself  to  be  of  great  practical  interest.  The  over- 
whelming difference  between  the  bowel  of  the  foetus  and 
the  bowel  of  the  independent  individual  is  not  so  much, 
I  think,  that  the  one  is  functioning  and  the  other  is  not, 
as  that  the  one  is  microbe-free  and  the  other  is  microbe- 
crammed.  Microbes  have  been  identified  in  the  bowel 
of  the  baby  so  soon  as  eleven  days  after  birth,  and  ther.e- 
after  they  never  leave  it.  At  this  moment  the  bowel  of 
every  civilized  being,  vrith  the  very  rare  exceptions  to 
which  I  am  about  to  allude,  contains  unthinkable  billions 
of   microbes.     Now   these  live,    of   course,   by   chemical 


IMMEDIATE  CAUSES  OF  CANCER        71 

processes,  and  their  activities  profoundly  modify  the 
whole  chemistry  of  the  bowel.  The  reader  will  readily 
understand  that  the  chemistry  of  a  microbe-free  bowel 
would  differ  incalculably  from  the  usual  case.  So  radical 
is  the  difference  that  I  would  suggest  as  at  least  credible 
a  totally  different  fate  for  trypsin  in  the  two  cases.  Now 
a  remarkable  and  original  student  of  digestion,  Mr.  Hor- 
ace Fletcher,  the  well-known  author  of  The  A  B-Z  of 
Our  Ozvn  Nutrition,  has  instituted  a  series  of  inquiries 
which  show  at  least  that,  whether  this  bacterial  condition 
of  the  bowel  be  normal  or  not,  at  any  rate  it  is  possible 
to  be  without  it,  and  to  flourish  exceedingly  in  mind  and 
body  withal.  We  must  admit  as  a  proved  scientific  fact 
that  it  is  possible  to  live  and  flourish,  even  to  the  extent 
of  arduous  athletic  exercise  and  arduous  intellectual  exer- 
cise, upon  what  is  really  only  a  minute  fraction  of  the 
food  commonly  consumed  by  civilized  man.  On  Mr. 
Fletcher's  principles  this  food  is  most  rigorously  masti- 
cated— so  rigorously  that  there  really  is  no  time  to  eat 
any  but  very  small  quantities.  Now  the  bowel  under 
these  conditions  would  seem  to  be  an  entirely  different 
place,  so  to  speak,  from  the  bowel  of  the  ordinary  man. 
The  "normal"  large  intestine — if  it  be  rightly  called 
normal — is  the  seat  of  continuous  microbic  decomposi- 
tions of  the  most  complicated  and  aggravated  character. 
In  cases  of  constipation  the  poisons  thereby  set  up  pro- 
duce notorious  effects.  But  what  would  constitute  for 
us  constipation  so  extreme  as  to  be  desperate,  and  suggest 
the  necessity  of  immediate  surgical  intervention,  is  for 
the  Fletcherite  his  normal  and  untroubled  state.  I  hope 
I  have  not  sacrificed  explicitness  to  elegance  in  putting 
the  facts  thus.  Now  it  seems  to  me  to  be  perfectly  credi- 
ble   that    the    Fletcherite    bowel,    which    is    practically 


7^  THE  CONQUEST  OF  CANCER 

microbe- free,  may  differ  from  the  ordinary  bowel  in  this 
respect  among  others — that,  like  the  bowel  of  the  foetus, 
it  permits  the  absorption  of  trypsin,  whereas  the  ordinary 
bowel  prevents  its  absorption  by  insuring  its  previous 
destruction.  The  fact  that  the  pancreas  produces 
zymogen  granules,  the  precursors  of  trypsin,  during 
several  months  of  foetal  life,  is  a  demonstrable  fact  which 
any  one  can  observe  for  himself  under  the  microscope. 
Confirmed  by  Barbera's  recent  work,  it  is  impossible  to 
question  that  fully  formed  trypsin  is  made  in  the  foetal 
bowel,  when  there  is  absolutely  nothing  whatever  for  it 
to  do  in  the  hozvel;  nor  is  there  any  difficulty  in  under- 
standing that  its  absorption  from  the  foetal  bowel  will  be 
easy  and  rapid;  whilst  Dr.  Beard  has  assigned  to  it  a  role 
momentous  enough  indeed.  Now  I  submit  that  the 
Fletcherite  bowel,  which  at  its  fullest  is  practically  empty, 
and  at  its  most  septic  is  practically  microbe-free,  approxi- 
mates so  nearly  to  the  condition  of  the  foetal  bowel,  that 
if  the  absorption  of  undestroyed  trypsin  is  credible  in  the 
one  case  it  is  credible  in  the  other. 

All  this,  of  course,  is  speculation,  but  it  is  speculation 
perfectly  capable  of  verification,  and  I  submit  that  while 
it  is  not  unreasonable  in  itself,  there  are  certain  facts 
which  are  in  consonance  with  it — certain  facts  indeed, 
which  by  this  speculation  may  be  explained.  In  a  word, 
I  suggest  that  in  many  cases  the  absorption  of  trypsin 
from  the  ordinary  bowel  of  civilized  man  is  practically 
or  wholly  impossible;  that,  however,  it  is  possible  in  the 
case  of  the  bowel  of  the  Fletcherite;  that,  as  judged  by 
results,  the  Fletcherite,  and  he  alone,  may  be  considered 
the  wise  and  healthy  eater,  while  the  rest  of  us  most 
grossly  over-feed  ourselves.  It  may  be,  then,  that  the 
very   large  number   of   facts   which   seem  to   show   an 


IMMEDIATE  CAUSES  OF  CANCER        73 

especial  incidence  of  cancer  in  the  well-to-do — that  is  to 
say,  in  the  most  grossly  over-fed  classes — ^the  facts  which 
show  that  it  is  especially  a  disease  of  man  as  against  the 
lower  animals  (in  whom,  except  when  domesticated,  it  is 
extremely  rare)  and  the  facts  which  show  that  it  is 
especially  a  disease  of  civilized  as  against  savage  man — 
are  all  capable  of  rational  and  scientific  explanation  in 
terms  of  the  hypothesis  which  I  here  venture  to  advance. 

It  has  been  frequently  asserted,  and  is  still  asserted, 
that  cancer  is  a  disease  of  over-nutrition ;  the  body,  being 
excessivelv  supplied  with  nourishment,  is  liable  to  over- 
growth, which  may  take  the  form  of  cancer.  That  as  it 
stands  is  a  crude  and  evidently  ridiculous  theory,  .entirely 
failing  to  reckon  with  the  wholly  anomalous  character 
of  the  so-called  over-growth  in  question ;  but,  on  the  other 
hand,  it  is  possible  to  suggest  that  the  three  series  of  facts 
already  named,  which  seem  to  associate  cancer  with  over- 
nutrition,  really  mean  that  the  person  whose  bowel  is  per- 
sistently filled  with  microbes  and  filth  is  thereby  pre- 
vented from  absorbing  into  his  blood  the  trypsin  which 
is  produced  in  his  bowel,  and  loses  the  preventive  influ- 
ence which  that  trypsin  might  otherwise  exercise  upon 
the  development  of  cancer. 

Needless  to  say,  I  am  prepared  to  abandon  this  specu- 
lation the  moment  that  it  is  disproved.  If,  for  instance, 
the  incidence  of  cancer  among  Fletcherites  can  be  shown 
to  be  as  high  among  other  people,  then  I  have  nothing 
more  to  say.  Meanwhile  I  submit  that  it  is  possible  to 
state  a  reasonable  case,  which  provides  a  new  argument 
against  over-eating,  graver  perhaps  than  any  hitherto 
adduced.^ 

^See  also  p.  202. 


CHAPTER  VIII 

THE  MICROSCOPIC  STUDY  OF  CANCER 

He  would  be  a  very  fool,  of  course,  who  denied  the 
magnificent  and  wholly  indispensable  part  which  the 
microscope  has  played  in  the  advance  of  medicine  and 
pathology.  Without  the  microscope  we  could  not  have 
the  cellular  pathology,  or  cell-theory  of  disease,  not  the 
least  important  teaching  of  which  is  the  universally  ad- 
mitted cell-theory  of  cancer.  It  is  also  impossible  to 
deny  that  the  microscopic  study  of  cancer  has  quite  lately 
accomplished  excellent  work,  as,  for  instance,  in  the  proof 
of  the  not  infrequent  occurrence  among  the  cells  of  some 
cancers  of  the  peculiar  type  of  division  which  had  pre- 
viously been  regarded  as  exclusively  characteristic  of  cer- 
tain stages  in  the  history  of  reproductive  tissue.  Great 
interest  and  significance  also  attach  to  the  recent  micro- 
scopic demonstration  by  Schmidt  of  the  fashion  in  which 
the  fluid  part  of  the  blood  is  enabled  to  inclose,  and  subse- 
quently to  kill,  cancer-cells  which  have  just  dissolved  or 
digested  their  way  through  the  walls  of  the  blood-vessels. 
It  may  be  suggested  that  trypsin  is  the  agent  here,  as 
indeed  in  the  positive  cases  of  the  spontaneous  cure  of 
cancer. 

But  it  is  not  too  much  to  say  that  there  is  an  all  but 
regrettable  aspect  which  the  microscopic  study  of  cancer 
presents  to  us,  as  Prof,  von  Leyden  observes  in  the  im- 
portant paper  in  which  he  announces  his  adherence  to 

74 


MICROSCOPIC  STUDY  OF  CANCER        75 

the  theory  of  Dr.  Beard  that  trypsin  has  a  specific,  select- 
ive, digestive  action  upon  certain  constituents  of  cancer- 
cells.  He  there  comments  upon  the  fact  of  the  very 
long  period,  amounting  to  something  like  half  a  century 
— a  period  now  happily  forever  closed — during  which  the 
study  of  cancer  has  been  carried  on  as  a  study  in  minute 
anatomy.  Morphology  being  the  science  of  form,  we 
may  say  that  until  this  present,  or  rather  until  the  work 
of  Dr.  Beard  broke  new  ground,  the  study  of  cancer  has 
been  morphological — that  is  to  say,  a  study  of  the  appear- 
ances found  under  the  microscope.  The  initial  discovery 
of  the  microscope  in  this  respect,  the  discovery  that  every 
malignant  tumor  consists  in  the  growth  of  cells  peculiar 
to  it,  and  antagonistic  to  the  normal  cells  of  the  body,  was 
of  course  a  fundamental  and  essential  one,  constituting, 
indeed,  the  first  great  epoch  in  the  history  of  the  subject. 

But  what  do  we  find  ?  The  facts,  indeed,  demonstrate 
what  is  so  lamentably  familiar  to  the  student  of  science. 
A  new  method  is  introduced  by  some  great  pioneer,  a 
Virchow  or  another ;  then  for  a  long  period  innumerable 
students,  endowed  with  honesty  and  perseverance  no 
doubt,  continue  to  prosecute  this  method — not  without 
results,  of  course.  But  there  is  a  limit  to  the  fertility  of 
any  scientific  method,  and  the  trouble  is  that  the  method 
which  has  proved  its  worth  becomes  a  fetish  to  its  prose- 
cutors, and  no  really  substantial  advance  is  made  until 
another  genius  arises  with  a  new  method.  The  solution 
of  the  problem  of  cancer  as  a  problem  in  morbid  embry- 
ology is  a  splendid  case  in  point.  The  further  solution 
of  the  problem  of  its  treatment  as  a  problem  in  specific 
cell  chemistry  is  yet  another. 

Let  us  now  see  how  jejune  have  been  the  usual  investi- 
gations of  cancer  by  the  microscopic  methods.     All  over 


76  THE  CONQUEST  OF  CANCER 

the  world  the  young  student,  introduced  to  the  subject  of 
malignant  tumors,  has  his  attention  directed  by  his 
pathological  teachers  almost  exclusively  upon  the  ques- 
tion of  minute  anatomy.  True,  he  has  learned  in  the 
laboratories  of  physiological  chemistry  that  cell  behavior 
is  a  matter  of  cell  chemistry.  True,  also,  if  he  reads 
Herbert  Spencer,  he  has  learnt  that  function  precedes 
and  creates  structure,  while  it  is  an  elementary  fact  of 
physiology-  that,  though  all  liver  cells  are  exactly  alike, 
yet  the  organ  which  they  comipose  has  at  least  half  a 
dozen  distinct  and  classifiable  chemical  functions.  Yet 
for  all  that,  the  trouble  is  that  the  academic  pathologist 
is  essentially  a  man  of  the  microscope,  and,  therefore, 
there  is  no  pathology  for  him  but  what  his  microscope 
reveals.  This  is  not  a  peculiarity  of  the  pathologist.  It 
is  only  the  consequence  of  the  law  of  the  mind,  which 
shows  itself  in  the  m.usician.  the  party  politician,  the 
cook,  or  any  one  else.  But  it  is  dissonant  with  the  facts 
of  nature,  which  are  m.ore  various  than  is  dreamt  of  in 
the  philosophy  of  any  specialist  of  any  order. 

Look  up  the  text-books,  and  we  find  page  after  sterile 
page  filled  with  what?  Not  the  function  of  the  cancer- 
cell,  which  is  eA'er}i;hing,  but  its  structure,  which  accord- 
ing to  all  the  laws  of  biology  is  nothing  but  a  labile 
modification,  created  by  the  function  as  its  servant. 
Hence  this  is  why  Sir  "William  Collins  was  so  profoundly 
right  when  he  said,  long  ago,  that  we  must  learn  from 
the  Spencerian  principles  of  cell  life,  if  we  would  solve 
the  problem  of  cancer.  Hitherto  the  medical  student 
spends  wear\-  weeks  at  home  and  in  the  laboratory  in 
order  that  he  m.ay  learn  at  a  glance  how  to  distinguish 
a  section  of  a  spindle-cell  sarcoma  from  a  section  of  a 
round-cell  sarcoma,  a  glandular  epithelioma  in  one  organ 


MICROSCOPIC  STUDY  OF  CANCER        77 

from  one  in  another  organ,  and  so  forth.  These  things 
will  be  shown  him  at  his  examination,  and  he  will  pass  or 
fail  according  as  he  can  or  cannot  name  them.  But 
the  names  matter  not  at  all.  Spindle  cell  or  round 
cell,  they  both  kill.  If  they  both  kill,  it  is  not 
the  round  cell  that  kills  because  it  is  round,  nor 
the  spindle  cell  because  it  is  a  spindle  (as  a  matter  of 
fact  these  terms  do  not  even  correctly  describe  their 
shape),  and,  therefore,  their  shape  is  demonstrably  a 
matter  of  no  moment.  If  they  do  not  kill  because  of 
their  shape,  let  us  hasten  to  the  serious  question,  which 
is,  Why  do  they  kill  ?  In  other  words,  five  seconds'  study 
under  the  microscope  of  any  two  different  sections  of 
malignant  tumors  demonstrates  to  any  one  who  will  think 
at  all  that  this  is  not  the  method  which  will  ever  lead 
anywhere.  All  that  the  microscope  can  reveal  is  differ- 
ence of  cell  shape ;  all  that  matters  a  straw  is  identity  of 
cell  action,  which  the  microscope  can  never  see.  But  the 
student  learns  from  one  teacher  that  malignant  tumors 
are  divided  into  these,  those  and  the  others.  However, 
he  is  to  be  examined  by  another  teacher,  whose  text-book 
states  a  different  division.  His  eye  travels  over  acres 
of  prints  and  notes,  trying  to  find  out  how  malignant 
tumors  are  divided.  Thousands  of  students  all  over  the 
world  are  doing  this  at  this  moment;  but  it  does  not 
matter  a  straw  how  malignant  tumors  are  divided.  The 
only  thing  that  matters  is  how  they  are  united.  They  are 
united  because  they  are  malignant,  and  they  are  malignant 
because  of  what  they  do.  This  microscopic  study  of 
cancer  is  very  much  less  rational  tha;n  would  be  the  choice 
of  a  Prime  Minister  or  an  orchestral  conductor  by  the 
cut  of  his  clothes.  A  man  usually  puts  on  his  clothes 
in  order  to  keep  countenance  with  his  company;  so  does 


78  THE  CONQUEST  OF  CANCER 

the  malignant  cell  change  its  shape,  but  not  its  essential 
malignancy. 

As  the  question  about  a  man  is,  What  is  he,  and  what 
does  he  ?  and  not,  Does  he  shave  his  chin  ?  so  the  question 
about  the  cancer-cell,  which  medical  science  has  prac- 
tically ignored  for  half  a  century,  is,  What  is  it,  and 
what  does  it  ?  and  not.  What  does  it  look  like  ?  It  is  not 
possible,  by  the  microscope,  and  never  will  be  possible, 
as  our  knowledge  of  the  limits  of  microscopic  vision  tells 
us,  to  see  the  inner  shrine  of  the  temple  of  life.  The 
ultimate  vital  processes  are  forever  hidden  from  the  eye 
of  man.  The  microscopic  stage  of  pathology  in  general, 
and  not  only  of  the  study  of  cancer,  was  a  necessary  and 
invaluable  one,  but  it  must  yield  to  something  deeper. 
To  my  mind,  the  analogy  with  astronomy  is  amazing. 
No  one  will  decry  the  telescope.  Modern  astronomy 
could  not  exist  without  it,  any  more  than  modern 
pathology  without  the  microscope.  But  there  came  the 
point  at  which  the  fertility  of  the  telescopic  method  was 
practically  exhausted.  It  could,  can  and  will  go  on 
indefinitely  adding  in  quantity  to  the  same  kind  of  knowl- 
edge as  that  already  attained  by  it.  Similarly  the  micro- 
scope will  go  on  adding  to  the  same  kind  of  knowledge 
as  that  already  gained  by  it.  But  if  you  desire  a  new 
kind  of  knowledge  you  must  introduce  a  new  method. 
In  astronomy  that  method  is  embodied  by  the  spectro- 
scope. The  telescope  can  see  a  distant  star,  but  the  spec- 
troscope can  enable  the  mind's  eye  to  see  the  structure 
of  the  atoms  in  that  star,  which  the  bodily  eye  could  not 
see,  however  near  to  it  they  were.  The  introduction  of 
the  spectroscope  has  created  a  whole  new  astronomy  to 
which  the  whole  preceding  astronomy  was  merely  a  mat- 
ter of  finding  out  our  whereabouts  and  obtaining  mate- 


MICROSCOPIC  STUDY  OF  CANCER        79 

rials  for  study.  The  introduction  of  bio-chemistry,  as 
it  is  called,  its  instruments  the  instruments  of  the  chemist, 
is  about  to  work  a  similar  revolution  in  the  whole  of 
biology,  including  morbid  biology,  which  we  call  pathol- 
ogy. Just  as  the  telescope  could  go  on  finding  out  new 
stars  indefinitely,  but  could  never  tell  us  what  they  really 
were,  so  the  microscope  may  go  on  indefinitely  finding 
out  new  shapes  of  malignant  cells.  I  should  say  that  the 
shapes  of  these  cells  are  probably  potentially  infinite, 
which  is  apparently  more  than  can  be  said  of  the  stars; 
but  in  order  to  find  out  what  these  cells  are,  the  only 
thing  that  matters,  a  new  method  is  necessary.  Dr. 
Beard  began  by  introducing  the  historical  or  embryologi- 
cal  method,  and  upon  it  he  based  a  conclusion  as  to  the 
specific  relation  of  trypsin  to  the  malignant  cell — a  con- 
clusion which  might,  or  might  not,  prove  to  be  identical 
with  the  conclusion  of  yet  another  method — the  chemical 
or  bio-chemical  method.  As  Prof,  von  Leyden  puts  it, 
the  question  really  worth  asking  now  is  whether  there 
are  specific  substances  peculiar  to  malignant  cells.  All 
malignant  cells  kill,  whatever  their  shape.  It  is  this  kill- 
ing that  concerns  us  who  are  killed.  In  this  they  agree 
with  each  other  and  differ  from  all  non-malignant  cells. 
Von  Leyden's  question,  then,  can  be  answered  without 
further  inquiry  by  the  use  of  pure  ratiocination.  It  is 
a  logical  necessity  that  there  must  be  such  specific  sub- 
stances, whilst  it  is  evidently  extremely  probable  that,  in- 
deed, they  will  be  found  to  be  one  group  of  such  common 
to  all  malignant  cells. 

The  next  question  is  whether  it  is  possible  to  produce 
a  specific  destruction  of  such  substance  or  substances : 
and  if  they  are  essential  to  the  life  of  the  cell  it  will  die. 
We  know  now  that  there  is  such  a  substance,  and  that 


80  THE  CONQUEST  OF  CANCER 

under  certain  conditions  trypsin  destroys  it.  Nothing 
could  bc'  simpler.  No  line  of  inquiry  could  now  seem  to 
be  more  clearly  indicated  for  the  student  of  cancer,  yet 
look  up  the  text-books  of  pathology,  and  see  what  we  find 
about  it.  If  ever  there  was  an  illustration,  here,  indeed, 
it  is,  which  vividly  expresses  the  biological  truth  that 
function  precedes  structure,  which  is  no  more  than  its 
creature  and  servant.  Furtherm.ore,  just  as  you  may 
change  your  servant  or  your  attire,  which  is  an  inanimate 
servant,  according  to  your  needs,  so  the  functioning  can- 
cer-cell, whose  interest  it  is  to  live,  and  not  to  make  itself 
circular,  or  spindle-shaped,  or  parallelopipedal,  or  any- 
thing else  in  particular,  will  assume  any  kind  of  shape — 
not  infrequently  in  imitation  of  the  tissues  among  which 
it  finds  itself.  This  microscopic  examination  has  grossly 
deceived  all  but  the  very  few  pathologists.  Conceive 
yourself  as  a  man  with  a  microscope,  who  runs  the  grave 
risk  of  having  his  inner  as  well  as  his  outer  vision  limited 
by  the  microscope.  You  see  malignant  cells  lying  beside 
cells  normal  to  such  a  gland  as  the  breast.  The  two  sets 
of  cells  look  very  like  one  another.  Perhaps  it  is  only  the 
misplacement  of  the  malignant  cells  which  distinguishes 
them  to  your  eye.  You  conclude,  therefore,  that  this  mis- 
placement is  the  essential  phenomenon.  How  many  gal- 
lons of  ink  have  not  been  spent  over  this  idea  of  misplace- 
ment as  constituting  the  real  distinction. 

But  if  you  are  wise,  even  as  you  gaze  down  the  micro- 
scope, you  will  keep  firmly  before  your  inner  vision  the 
capital  fact,  which  what  you  see  there  tends  to  obscure — 
•the  fact  that  the  normal  cell  and  the  malignant  cell  next 
it,  though  they  look  like  brothers,  are  fundamentally  and 
essentially  not  so.  What  fact,  indeed,  could  more  clearly 
indicate  the  subordinacv  of  structure  than  this  fact  which 


MICROSCOPIC  STUDY  OF  CANCER        81 

every  pathologist  knows?  It  is  universally  admitted  by 
the  pathologists  that  they  cannot  tell  a  single  cancer-cell 
to  be  a  cancer-cell.  The  most  they  can  go  by — and  they 
are  frequently  wrong,  as  every  clinician  knows — is  simply 
this  question  of  the  invasion  or  misplacement  which  the 
growing  edge  of  a  tumor  may  show.  Yet  in  face  of  the 
fact  that  of  two  cells  which  cannot  be  told  apart  nor  even 
together,  one  may  be  a  normal  cell  of  the  body,  while  the 
other — and  no  one  can  say  which  is  which — is  an  enemy 
of  the  whole  body,  and  will  certainly  kill  and  destroy  the 
first ;  in  face  of  the  fact,  indeed,  that  the  two  cells  differ 
as  widely  as  any  cells  can  differ,  for  there  is  no  cell  differ- 
ence more  extreme  than  that  the  life  of  either  should 
mean  the  death  of  the  other — in  face  of  this  fact  the 
microscope  fetish  is  still  worshipped.  Monstrous  at  first 
sight  may  appear  Dr.  Beard's  assertion  that  these  two 
apparently  identical  cells  actually  belong  to  different  gen- 
erations in  the  animal  life-cycle,  yet  what  assertion  of 
their  fundamental  difference  can  possibly  demonstrate  it 
more  clearly  than  the  familiar  facts  of  their  actual  vital 
relations  to  one  another? 

Misled  by  appearances,  the  pathologists  teach  that  the 
malignant  cell  is  simply  one  of  the  cells  of  the  part,  which 
differs  in  having  taken  on  powers  of  unlimited  growth. 
Nothing  is  more  commonly  repeated  about  malignant 
tumors  than  this.  But  unlimited  growth  as  such  is  not 
peculiar  to  the  cancer-cell,  and  if  it  differed  in  nothing 
but  this,  cancer  would  not  be  cancer.  It  is  the  innocent 
tumor,  the  harmless  fatty  tumor,  for  instance,  that  dis- 
plays exactly  what  pathologists  assert  to  be  the  differ- 
entia of  the  malignant  cell — power  of  unlimited  growth. 
The  cardinal  fact  about  the  malignant  cell  is  not  that  it 
grows  indefinitely,  though  that  is  true,  but  the  fact  that 


82  THE  CONQUEST  OF  CANCER 

it  grows  by  killing  the  normal  cells  and  destroying  normal 
tissues,  which  is  exactly  what  the  cells  of  a  fatty  tumor, 
with  their  power  of  unlimited  growth,  never  do. 

In  a  word,  the  only  thing  really  worth  seeing  in  a 
cancer-cell,  the  something  by  which  it  kills,  is  precisely 
that  which  the  microscope  can  never  see. 


CHAPTER  IX 

LIFE   AND  FERMENTATION 

Doubtless  the  microscopist  is  not  wrong  in  his  as- 
sumption that  the  minute  anatomy  of  cancer  would  tell 
us  much  that  it  vitally  concerns  us  to  know.  But  the 
anatomy  that  really  matters  is  molecular,  and  almost  in- 
finitely more  minute  than  the  most  delicate  features  which 
the  present  microscope  or  any  future  microscope  can  dis- 
cern. In  the  next  chapter  I  shall  discuss  certain  general 
considerations  regarding  the  chemistry  or  molecular 
anatomy  of  cancer,  following  in  this  respect  the  greater 
part  of  Dr.  Beard's  latest  paper  :^  whilst  the  more  imme- 
diately practical  aspects  of  this  question — which  we  have 
already  seen  to  be  the  fundamental  question  of  cancer — 
will  be  discussed  in  the  chapter  wherein,  for  the  con- 
venience of  the  serious  student,  I  consider  as  a  whole  the 
recent  German  contributions  to  this  subject. 

Meanwhile  it  is  desirable  that  we  should  study  certain 
general  facts  as  to  the  relation  between  life  and  fermenta- 
tion. These  will  enable  us  to  see  that  the  subject  of 
fermentation  goes  to  the  very  basis  of  the  structure  and 
function  of  all  living  cells  whatsoever :  and  it  may  become 
evident  as  a  necessary  truth  that  in  fermentation,  and  in 
that  alone,  we  have  the  key  to  the  control  of  vital 
processes  in  general,  whether  in  order  to  arrest  or  facili- 

^In  passing  this  page  for  press,  I  learn  that  this  paper  appeared 
in  the  New  York  Medical  Record,  Oct.  19,  1907. 

83 


84  THE  CONQUEST  OF  CAXCER 

tate  or  direct  them.  There  is  no  question  as  to  the  uni- 
versal importance  of  the  subject,  quite  apart  from  the 
problem,  of  cancer. 

It  has  frequently  been  declared  that  life  itself  is  nothing- 
but  a  series  of  ferm.entations.  It  is  now  believed  that  the 
stimulant  action  of  the  sperm  in  initiating  development  is 
that  of  a  ferment.  Yet  again,  it  is  fermentation  that 
produces  alcohol,  with  its  incalculably  malignant  conse- 
quences ;  and  lastly,  the  action  of  a  ferment  is  in  itself 
so  wonderful  a  thing,  and  so  closely  suggestive  of  the 
behavior  of  a  living  creature,  that  the  student  of  the 
nature  of  life  might  well  spend  the  brief  span  of  his  own 
life  upon  this  subject  alone. 

I\Ien  have  known  for  long  ages  that  if  something  called 
yeast  be  added  to  a  solution  of  sugar  there  is  a  dis- 
turbance in  the  fluid,  with  the  production  of  gas  and 
bubbles  and  froth,  and  of  alcohol :  but  the  matter  was  not 
understood. 

In  the  early  part  of  last  century,  however,  the  great 
German  chemist.  Liebig,  formed  a  theory  as  to  the  causa- 
tion of  fermentation,  not  to  mention  the  putrefaction 
which  is  going  on  everywhere,  and  this  w^e  may  call  the 
chemical  theory.  There  must  be  certain  substances 
called  ferments  which,  by  some  chemical  property,  excite 
these  striking  and  vastly  important  processes. 

Then  there  arose  a  chemist  yet  more  illustrious,  the 
Frenchman,  Louis  Pasteur,  and  he,  fortified  by  the  newly 
discovered  fact  that  yeast  is  a  living  creature,  denied 
altogether  the  chemical  theory  of  Liebig,  and  produced 
a  large  number  of  facts  which  seem.ed  to  show  that  all 
fermentation  and  putrefaction  are  the  work  of  living 
creatures.  These  it  contented  him  to  call  microbes,  as 
a  comprehensive  and  not  too  precise  term.     This  was  a 


LITE  AND  FERMENTATION  85 

vital  theory  of  fermentation,  as  opposed  to  the  chemical 
theory  of  Liebig,  and  it  was  admitted  on  nearly  all  hands 
that  Pasteur  was  right  and  Liebig  wrong. 

However,  there  were  discovered  the  digestive  ferments, 
such  as  pepsin,  with  the  name  of  which  we  are  all  fa- 
miliar, while  trypsin  was  discovered  in  1858,  very  nearly 
half  a  century  ago.  Now  these  substances  are  not  living 
cells.  Furthermore,  we  now  know  that  alcoholic  fermen- 
tation is  immediately  produced  by  a  non-living  ferment 
which  has  actually  been  extracted  from  the  bodies  of  the 
yeast-cells.  There  are,  then,  many  ferments  which  are 
not  alive,  but  these  are  produced  in  and  by  living  cells — 
yeast-cells,  the  gland-cells  of  the  stomach,  the  pancreas, 
the  salivary  glands,  and  so  on. 

Each  of  the  two  great  chemists  had  half  the  truth. 
Pasteur  was  right  in  his  assertion  that  fermentation  is 
due  to  life.  Liebig  was  right  in  his  assertion  that  fer- 
mentation is  a  process  due  to  the  chemical  action  of 
lifeless  chemical  substances.  We  enter  into  and  profit 
by  the  labors  of  both  great  controversialists. 

At  present  we  commonly  speak  of  organized  ferments 
and  unorganized  ferments,  meaning  thereby  living  fer- 
ments in  the  first  place  and  not-living  ferments  in  the 
second.  This  is  a  thoroughly  unfortunate  manner  of 
speech,  which  should  best  be  dismissed.  If  it  were  to  be 
persisted  in  we  should  have  to  call  every  living  cell  an 
organized  ferment,  for  every  living  cell  produces  fer- 
mentation. It  is  probable  that  even  the  fundamental  act 
of  breathing,  the  taking  in  of  oxygen  and  the  burning 
up  of  food  with  it,  is  controlled  by  a  respiratory  ferment 
— and  every  living  cell  must  breathe  or  die.  I  shall 
entirely  confine  the  word  ferment  here,  therefore,  to  those 
chemical  compounds — ;which  it  would  be  absurd  to  call 


86  THE  CONQUEST  OF  CAXCER 

unorganized,  since  they  are  so  highly  organized  that  we 
can  only  guess  at  their  structure — which  are  the  imme- 
diate cause  of  fermentations  ;  and  we  may  begin  by  asking 
ourselves,  in  general,  what  a  ferment  is. 

Ferments  in  general  are  very  complicated  chemical 
compounds,  produced  by  living  cells  for  their  own  pur- 
poses, and  acting  in  the  dissolved  state  in  water — liquid 
water  being  found  in  all  living  tissues.  But  it  is  quite 
possible  to  obtain  ferments  in  the  dry  state ;  trypsin,  for 
instance,  may  be  obtained  as  a  mere  whitish-yellow  pow- 
der; it  may  be  kept  in  this  state  for  long  periods,  and 
after  being  dissolved  again  may  retain  some  of  its  activ- 
ity. Every  one  is  familiar  with  pepsin  in  the  form  of  a 
powder  or  even  a  tablet.  The  number  of  ferments  is, 
perhaps,  necessarily  as  large  as  the  number  of  the  va- 
rieties of  animals  and  plants,  but  in  general  they  answer 
to  this  description.  It  is  probable  that  trypsin  is  a  highly 
complex  proteid  or  albuminous  substance,  of  the  class 
called  colloids,  and  it  is  a  typical  ferment.  All  ferments 
are  very  sensitive  to  changes  in  temperature,  and  all  of 
them,  when  dissolved  in  water,  are  rapidly  destroyed  at 
the  very  moderate  temperature  ('60-65''  C.)  at  which 
proteid  or  albumin,  such  as  white  of  egg,  becomes  solid. 
Ferments  in  certain  states  stand  low  temperatures  ex- 
tremely well.  It  seems  to  me  that  this  is  a  very  inter- 
esting fact,  if  we  remember  that  microbes  will  stand  the 
temperature  of  liquid  air  for  weeks.  Sunlight  rapidly 
destroys  most  ferments,  and  so  do  such  familiar  sub- 
stances as  hydrochloric  acid.  Since  this  is  the  digestive 
acid  produced  by  the  stomach  we  may  readily  understand 
that  pepsin  is  a  conspicuous  exception  to  this  rule,  and 
acts  most  A'igorously  in  the  presence  of  a  quantity   of 


LIFE  AND  FERMENTATION  87 

hydrochloric  acid  which  would  instantly  destroy  prac- 
tically all  other  ferments. 

From  the  chemical  point  of  view,  perhaps  the  most 
remarkable  fact  about  the  ferments,  in  general,  is  the 
extreme  simplicity  of  the  means  by  which  they  produce 
results  so  potent  that  without  them  there  would  be  no 
life  upon  the  earth.  We  may  practically  say  that  all 
ferments  either  add  oxygen  to  other  substances  or  take 
it  away,  or  add  water  or  take  it  away ;  that  is  all.  Mean- 
while the  ferment  itself — and  this  is  the  capital  fact — 
remains  unchanged.  While  it  is  producing  the  most  ex- 
traordinary results,  changing  the  face  of  the  earth,  itself 
remains  unchanged  and  loses  none  of  its  power.  Its 
mere  presence  suffices.  This,  of  course,  is  the  standing 
puzzle  about  which  chemists  have  been  puzzling  their 
brains  for  three-quarters  of  a  century,  and  it  constitutes 
the  essential  difference  between  ferments  and  the  power- 
ful chemicals  with  which  we  are  all  familiar.  Strong 
nitric  acid  will  do  big  things,  but  a  given  amount  of  nitric 
acid  will  only  do  a  given  amount  of  work,  and  it  is  utterly 
destroyed  in  the  process.  The  amount  of  work  which 
can  be  done  by  the  millionth  part  of  a  grain  of  a  ferment 
is  absolutely  and  literally  infinite.  This  is  one  of  the 
greatest  facts  in  the  whole  realm  of  science  if  it  be  prop- 
erly considered. 

Now  if  it  be  that  the  chemical  actions  induced  by 
ferments  are  so  extremely  simple,  why  should  they  be 
of  so  many  different  kinds?  Our  digestive  apparatus 
alone,  quite  apart  from  the  rest  of  the  body,  produces 
ferments  the  number  of  which  may  probably  be  reckoned 
by  the  dozen.  Why  should  there  be  so  many  different 
kinds  of  ferments,  all  capable  of  doing  only  the  same 


88  THE  CONQUEST  OF  CANCER 

thing,  such  as  causing  other  substances  to  part  with  their 
water  or  to  take  water  in  ? 

The  answer,  and  it  is  a  most  important  one,  is  that 
though  a  hundred  different  ferments  may  all  do  just  one 
and  the  same  thing,  there  may  yet  be  only  one  substance 
upon  which  any  one  of  them  will  act.  This  fact  we  may 
call,  to  use  technical  terms,  the  specific  nature  of  ferment 
action.  Prof.  Emil  Fischer  of  Berlin,  far  and  away  the 
greatest  living  student  of  organic  chemistry,  now  that 
the  illustrious  Berthelot  has  departed,  has  studied  this 
question,  and  he  has  actually  shown  that  of  two  sub- 
stances identical  in  composition  and  in  every  character 
— except  that  they  differ  in  structure  as  your  left  hand 
differs  in  structure  from  your  right — a  given  ferment 
will  act  upon  the  one  and  not  upon  the  other.  As  Fischer 
puts  it,  the  ferment  and  the  substance  to  be  fermented 
must  fit  like  key  and  lock,  or  nothing  happens  at  all. 
The  reason  why  the  number  of  ferments  or  keys  is  count- 
less is  evidently  to  be  found  in  the  number  of  different 
locks  that  have  to  be  opened.  Fischer's  extraordinary 
discovery,  to  which  I  have  alluded,  reminds  us  of  the  first 
discovery  made  by  Pasteur  himself,  who  showed  that 
certain  kinds  of  microbes  ate  up  and  destroyed — that  is 
to  say,  fermented — particular  solutions  of  sugar  made  up 
of  what  we  may  call  right-handed  molecules,  but  had  no 
action  upon  other  solutions  absolutely  identical,  except 
that  the  molecules  were,  so  to  speak,  left-handed.  Such 
great  advances  has  Fischer  made  that  in  many  cases  he 
can  actually  predict  from  the  structure  of  a  substance 
whether  a  given  ferment  will  attack  it  or  not — that  is  to 
say,  what  particular  key  will  fit  a  particular  lock. 

These  facts  are  interesting  from  many  theoretical 
points  of  view,  but  here  we  must  specially  consider  their 


LIFE  AND  FERMENTATION  89 

bearing  upon  the  new  discoveries  regarding  cancer.  Ac- 
cording to  Dr.  Beard,  looking  at  the  matter  entirely  from 
the  biological  point  of  view,  trypsin  is  capable  of  digest- 
ing certain  substances  necessary  to  the  life  of  the  cancer- 
cell,  but  has  no  action  upon  the  corresponding  substances 
which  are  found  in  the  healthy  cells  of  the  body.  The 
German  workers  have  exhaustively  proved  this  by  experi- 
ment, as  we  shall  see.  His  theory  exactly  fits  in  with 
what  the  chemists  have  taught  as  to  the  nature  of  fer- 
ments. The  substances  characteristic  of  a  cancer-cell 
may  differ  from  those  characteristic  of  a  body-cell  only 
just  so  much  as  your  right  hand  differs  from  your  left,  or 
as  the  drawing  of  a  knife  differs  from  that  drawing  seen 
in  a  mirror.  Yet  even  if  the  difference  be  no  greater  than 
this,  the  theory  that  trypsin  should  attack  the  one,  but  not 
the  other,  is  perfectly  consistent  with  everything  that  the 
chemists  have  taught  us  about  ferments.  Those  who  have 
criticized  this  part  of  the  theory  on  account  of  its  im- 
probability would  have  praised  it  as  reasonable  and  prob- 
able if  they  had  taken  the  precaution  of  first  acquainting 
themselves  with  the  elementary  facts  of  the  ferments. 

But  the  immediate  object  of  this  chapter  is  to  present 
to  the  reader  the  facts  of  fermentation  in  general,  and 
I  must  pass  on  at  once  to  mention  the  existence  of  certain 
perfectly  simple  inorganic  substances  which  are  also  capa- 
ble of  producing  fermentation.  Even  as  long  ago  as  the, 
time  of  Faraday,  it  was  discovered  that  such  a  substance 
as  platinum  is  capable  of  causing  what  cannot  be  dis- 
tinguished from  fermentation— and  this  more  especially 
if  the  platinum  be  finely  divided,  as  in  the  case  of  plati- 
num black.  Some  idea  of  the  power  of  these  substances 
may  be  gained  from  the  fact  that  the  action  of  one-three- 
hundred-thousandth  part  of  a  milligramme  of  platinum 


90  THE  CONQUEST  OF  CANCER 

"upon  more  than  a  million  times  its  weight  of  hydrogen 
peroxide"  could  still  be  detected.  Xow  a  milligramme 
is  a  thousandth  part  of  a  gramme,  and  that  is  only  fifteen 
grains.  A\'e  get  into  very  deep  waters  when  we  begin  to 
study,  as  we  may,  the  fashion  in  which  poisons,  such  as 
prussic  acid,  will  arrest  this  action  or  retard  it ;  and  we 
begin  to  ask  ourselves  whether  the  poisonous  action  of 
prussic  acid  upon  ourselves  is  not  simply  due  to  its 
arrest  of  certain  fermentations  which  are  necessary  for 
our  lives. 

For,  indeed,  it  seems  to  be  true  that  life  is  a  series  of 
fermentations.  The  reader  will  observe  that  I  am  not 
making  any  nonsensical  statements  about  the  supreme 
fact  called  mind.  The  physical  fact  called  life,  however, 
does  indeed  seem  to  consist  of  a  complicated  chain  of 
fermentations,  and  to  be  carried  on  by  means  of  ferments. 
As  most  of  us  know,  the  whole  system  of  life-processes 
on  our  planet  must  be  traced  to  the  wonderful  activity 
of  the  green  matter  of  plants,  and  in  all  probability  we 
must  look  upon  that  green  matter,  which  is  called  chloro- 
phyll, as  the  first  and  greatest  of  ferments,  which  makes 
possible  the  existence  of  all  other  life  and  all  other  fer- 
ments. Abolish  the  green  plant,  and  every  animal  upon 
the  planet  must  die,  whether  it  be  called  worm,  or  fish, 
or  man.  In  the  last  resort  we  are  all  vegetarians,  every 
mother's  son  of  us,  whether  we  consume  grass  directly 
or  the  ox  that  consumes  the  grass. 

More  than  this,  all  our  most  intimate  and  necessary 
vital  processes  are  now  seen  to  depend  upon  fermenta- 
tion. Absolutely  the  most  fundamental  process  of  all 
life  is  breathing,  and  there  is  definite  evidence  to  prove 
the  existence,  as  I  have  said,  of  a  ferment  for  this  pur- 
pose.    The  next  most  fundamental  vital  process  is  diges- 


LIFE  AND  FERMENTATION  91 

tion.  and  all  digestion  whatsoever  is  nothing  else  but  fer- 
mentation. 

Furthermore,  not  merely  do  the  processes  of  all  life 
depend  on  ferments,  but  there  are  certain  ferments  of 
very  humble  kinds  without  which  the  earth  would  soon 
becom.e  a  vast  charnel-house.  Putrefaction  is  not  a  pretty 
v.-ord,  and  the  process  is  not  beautiful  to  observe,  but 
without  it  all  life  upon  the  earth  would  shortly  have  to 
cease.  To  speak  of  microbes  as  if  they  were  all  ma- 
lignant is  wholly  erroneous.  Every  living  thing  must 
die  sooner  or  later;  yet,  as  we  know,  though  life  has 
flourished  upon  the  earth  for  untold  ages,  and  though  liv- 
ing creatures  have  died  in  unthinkable  millions  through- 
out even,^  year  of  those  ages,  the  earth  is  not  covered 
mountain  high  with  corpses.  All  dead  bodies,  animal 
or  vegetable,  high  or  low,  terrestrial  or  marine,  are  re- 
solved by  microbes  into  simple  elements  which  are  thereby 
set  free  for  the  service  of  the  generations  to  come.  The 
bacteria  of  putrefaction  suggest  nothing  wonderful,  least 
of  all  do  they  suggest  life.  Yet  at  any  moment  these 
germs  of  death  are  necessary  links  in  the  chain  which 
leads  to  future  life.  Thus  the  ferments  b}^  which  these 
microbes  do  their  work  must  earn  our  recognition.  With- 
out their  powers  mankind  could  never  have  been  pro- 
duced at  all.  To-da}^,  as  throughout  the  ages,  they  con- 
tinue the  work  of  putrefaction,  which  to  the  superficial 
eye  is  nothing  but  hideousness  and  horror,  but  to  the 
seeing  eye  has  in  it  the  promise  of  all  the  life  that  is  to 
be.  Every  living  creature  must  die  and  return  to  the 
dust.  There  its  body  is  resolved  by  fermentation  into 
the  simple  substances  which  we  often  call  manure.  The 
wisest  of  the  poets  have  seen  the  beauty  and  the  wonder 
of  this  process,  as  in  Tennyson's  couplet : 


92  THE  CONQUEST  OF  CANCER 

"And  from  his  ashes  may  be  made 
The  violet  of  his  native  land," 

and  Hamlet's: 

"And  from  her  fair  and  unpolluted  flesh  may  violets  spring." 

Thus,  if  the  fermentations  which  result  in  life  cannot 
avert  inevitable  death,  yet  all  death  in  virtue  of  fermenta- 
tion makes  for  future  life.  You  may  be  selfish  for  a  cen- 
tury, but  at  the  last  others  will  claim  your  dust,  and  we 
are  linked  throughout  the  ages,  "Buried,  and  breathing 
and  to  be,"  as  George  Meredith  has  said. 

Lastly,  I  believe  that  in  the  complete  solution  of  the 
problems  of  fermentation  wdll  be  found  the  revelation  not 
only  of  the  physical  nature  of  life,  but  of  its  origin  upon 
the  earth.  Robert  Louis  Stevenson  saw  deeply  when  he 
said  that  even  mankind  is  in  a  sense  the  "vital  putrefac- 
tion of  the  dust." 

We  must  be  fair,  then,  in  our  reckoning  with  the  fer- 
ments. They  hold  the  keys  both  of  life  and  death.  The 
ferment  of  the  yeast  plant,  with  its  product  alcohol,  has 
cursed  our  kind  for  ages,  and  curses  it  to-day.  All  the 
diseases  of  which  we  die  may  be  expressed  in  terms  of 
morbid  fermentation;  but  on  the  other  hand,  life  itself, 
physically  considered,  is  a  series  of  fermentations.  Even 
when  it  is  threatened  by  disease,  such  as  cancer,  the  in- 
troduction of  a  new  series  of  fermentations  may  avert 
death ;  and  without  the  ferments  by  means  of  which  the 
microbes  of  putrefaction  do  their  work,  the  whole  history 
of  life  upon  the  earth  would  have  been  no  more  than  the 
history  of  a  rocket,  full  of  apparent  promise,  but  doomed 
to  instantaneous  destruction. 


CHAPTER  X 

THE  CHEMISTRY  OF   CANCER 

Louis  Pasteur,  one  of  the  supreme  interpreters  of 
Nature  of  all  time,  was  "a.  mere  chemist,"  and  "not  even 
a  medical  man."  Nevertheless,  he  was  one  of  the  makers 
of  modern  biology  and  the  father  of  preventive  medi- 
cine. Before  we  consider  the  relation  of  his  work,  as 
Dr.  Beard  sees  it,  to  our  present  subject,  it  will  be  not 
inappropriate,  in  the  light  of  recent  events,  to  quote  cer- 
tain words  of  his  which  may  be  commended  to  the  gen- 
eral consideration  to-day:  "What,"  he  said,  "I  have 
been  engaged  for  twenty  years  in  research  on  a  subject, 
and  have  no  right  to  an  opinion !  And  the  right  of  veri- 
fying-, controlling,  discussing  and  questioning  belongs 
more  especially  to  him  who  has  done  nothing  to  clear 
up  the  matter,  to  one  who  has  just  read  my  works  more 
or  less  attentively,  with  his  feet  on  the  mantelpiece !" 

Pasteur's  first  original  piece  of  work,  and  that  which 
led  him  astray,  as  his  great  teachers  Dumas  and  Biot 
thought,  from  chemistry  (so  that  he  ultimately  created 
the  science  of  bacteriology),  was  the  discovery  that  cer- 
tain living  organisms  will  digest  or  ferment  certain  mole- 
cules of  tartaric  acid,  while  leaving  untouched  other 
molecules  identical  in  all  respects  except  that  they  differ 
as  a  right  hand  differs  from  a  left.  The  key  fits  the  lock, 
the  hand  the  glove :  but  the  right  hand  will  not  fit  a  left- 
handed  glove. 

Since  the  one  set  of  crystals  rotates  the  plane  of  a 
ray  of  polarized  light  to  the  right,  and  the  other  rotates 

93 


94  THE  CONQUEST  OF  CANCER 

it  to  the  left,  the  first  are  called  dextro-rotatory,  and  the 
second  lasvo-rotatory.  The  yeast  ferment  acts  upon  the 
Isevo-tartrate  only;  the  ferment  of  the  mold,  Penicillium, 
acts  upon  the  dextro-tartrate  only. 

The  two  sets  of  crystals  are  called  isomeric  or  isomers ; 
and  the  fact  is  noteworthy  that  when  any  of  these 
isomeric  compounds  are  manufactured  in  the  laboratory, 
the  result  appears  to  be  neutral  to  the  ray  of  polarized 
light.  This  is  due  not  to  the  creation  of  a  neutral  isomer, 
but  to  the  fact  that  the  product  is  really  a  mixture  in 
equal  proportions  of  the  dextro  and  the  Isevo  compounds. 
Pasteur  noted,  indeed,  that  all  the  artificial  products  of 
the  laboratory,  unlike  all  naturally  occurring  organic 
compounds,  are  without  action  on  polarized  light:  they 
consist  of  equal  proportions  of  oppositely-acting  com- 
pounds ;  but  they  can  be  separated  from  each  other  by 
the  action  of  specific  ferments.  In  the  words  of  Duclaux, 
Pasteur's  successor,  "Nature  alone  knows  how  to  manu- 
facture the  one  isomer  without  producing  the  other.  A 
living  cell  is  a  laboratory  of  dissymmetrical  forces,  or  a 
dissymmetrical  protoplasm,  acting  under  the  influence  of 
the  sun." 

"I  have,  in  fact,"  said  Pasteur  in  i860,  "set  up  a  theory 
of  molecular  asymmetry,  one  of  the  most  important  and 
wholly  surprising  chapters  of  science,  which  opens  up  a 
new,  distant,  but  definite  horizon  for  physiology." 

This  great  doctrine  is  now  recognized  to  depend  upon 
the  fact  of  the  "asymmetry  of  the  carbon  atom,"  first 
stated  by  Van't  Hoff  and  Le  Bel.  It  is,  indeed,  a  chief 
tenet  of  the  new  science  of  stereo-chemistry,  or  the 
chemistry  of  three-dimensioned  space,  which  conceives 
of  molecules  as  "solid"  things,  extended  in  the  three 
dimensions  of  space.     Since  the  carbon  atom  is  asym- 


THE  CHEMISTRY  OF  CANCER  95 

metrical — and  also  the  five-handed  or  pentavalent  nitro- 
gen atom,  as  Wislicenus  declared  in  1877 — isomeric  com- 
pounds in  general  may  be  built  up  in  two  directions,  so 
that  the  one  compound  is  the  mirror-image  of  the  other. 
The  classical  instance  is  the  carbon  compound  called  tar- 
taric acid,  as  investigated  by  Pasteur.  We  shall  now 
see  that,  according  to  Dr.  Beard,  this  initial  discovery 
of  Pasteur  actually  constituted  the  foundation  of  the 
science  of  ferments,  zvith  all  that  depends  upon  it. 

Pasteur's  work  began  with  this  discovery  of  an 
antithesis ;  and  Dr.  Beard's  work,  as  we  know,  began  with 
the  discovery  of  an  antithesis  between  structures  peculiar 
to  alternate  generations  in  the  life-cycle  of  a  fish.  It  is 
now  his  contention  that  the  "antithetic  alternation  of  gen- 
erations," as  he  calls  it,  ultimately  depends  upon  the  same 
fact  as  the  antithesis  discovered  by  Pasteur,  viz.  the  asym- 
metry of  the  carbon  atom.  That  "laboratory  of  dissym- 
metrical forces,"  which  we  call  the  cell,  builds  up  certain 
molecules  in  one  generation  and  their  mirror-images  in 
the  next. 

Dr.  Beard  quotes  the  observation  of  Mellor,  "that  only 
the  dextro-sugars  occur  in  nature,  and  that  these  are  the 
only  sugars  which  can  be  assimilated  as  foodstuffs  by 
the  yeast  plant."  Hence,  according  to  Pope  (Nature, 
vol.  68,  p.  280,  1903)  :  "It  would  seem  to  follow,  as  a 
legitimate  conclusion,  that  while  dextro-glucose  is  a  valu- 
able foodstuff,  we  should  be  incapable  of  digesting  .  .  . 
lasvo-glucose.  Humanity  is  therefore  composed  of  dex- 
tro-men  and  dextro-women.  And  just  as  we  ourselves 
would  probably  starve  if  provided  with  food  enantio- 
morphously^  related  to  that  to  which  we  are  accustomed, 

^Enantiomorphism  was  Pasteur's  name  for  the  relation  between 
a  compound  and  its  mirror-image. 


96  THE  CONQUEST  OF  CANCER 

so,  if  .  .  .  Isevo-men  were  to  come  among  us  now 
.  .  .  we  should  be  unable  to  provide  them  with  the  food 
necessary  to  keep  them  alive."  Pasteur  himself  remarks  : 
"Perhaps  this  will  disclose  a  new  world  to  us.  Who  can 
foresee  the  organization  that  living  matter  would  assume, 
if  cellulose  were  Icevo-rotatory,  instead  of  being  dextro- 
rotatory, or  if  the  Isevo-rotatory  albumins  of  the  blood 
were  to  be  replaced  by  dextro-rotatory  bodies?" 

Says  Dr.  Beard :  "In  the  light  of  the  antithetic  alter- 
nation of  generations  and  of  the  natural  antithesis  of  the 
compounds  arising  in  the  two  generations,  the  following 
passage  from  p.  283  of  Professor  Pope's  address  is  of 
interest.  It  is  also  instructive  in  view  of  the  generally 
accepted,  but  false,  views  of  the  question.  'Again,  sup- 
pose that  at  its  origin  life  were  carried  on  non-enan- 
tiomorphously,  and  that  it  involved  the  consumption  and 
the  production  only  of  non-enantiomorphous  substances 
and  of  compensated  mixtures,  it  may  well  be  foreseen  that 
a  stage  in  development  might  arise  when  each  individual, 
in  view  of  the  increasing  complexity  of  his  vital 
processes,  would  have  to  decide  to  use  only  the  one 
enantiomorphous  component  of  his  compensated  food, 
and  so  evade  an  otherwise  necessary  duplication  of  his 
digestive  apparatus.  Acting  intelligently  or  fortuitously, 
one-half  of  the  individuals  would  become  dextro-beings, 
while  the  other  half  would  become  Isevo-individuals ;  the 
succeeding  generations  would  thus  be  of  two  enantio- 
morphously  related  configurations.'  He  then  goes  on  to 
express  his  own  opinion,  that  in  course  of  time  one  con- 
figuration, the  weaker  one,  would  permanently  disappear. 
But  in  this  opinion  the  facts  of  botanical  and  embryolog- 
ical  science  are  not  taken  into  account.  It  is  only,  how- 
ever,   necessary   to    make    the    'succeeding   generations' 


THE  CHEMISTRY  OF  CANCER  97 

spoken  of  alternate,  in  order  to  meet  the  scientific  require- 
ments of  Nature,  and  so  to  make  the  passage  absolutely 
true  as  a  statement  of  scientific  fact.  This  is  done  by 
inserting  in  the  closing  passage  the  word  'alternating,' 
when  it  would  read :  'The  succeeding  generations  alter- 
nating would  thus  be  of  two  enantiomorphously  related 
configurations.'  " 

Dr.  Beard  notes  how,  in  these  two  last  quotations,  we 
may  find  at  least  a  hint  of  the  conceivable  existence  of  an 
antithetic  generation  in  which  the  chemical  compounds 
are  enantiomorphously  related  to  those  in  our  own  bodies. 
In  order  to  exist,  the  "Isevo-men"  of  Pope  "would  need 
to  be  able,  by  means  of  ferments,  to  pull  down  all  our 
food-substances,  and  to  rebuild  in  the  opposite,  or 
enantiomorphously  related,  or  antithetic  direction." 
"But,"  says  Dr.  Beard,  "these  hypothetical  'Isevo-men'  do 
exist  among  us,  and  they  do  pull  down  and  build  up 
again  in  the  opposite  direction,  for  the  'Iccvo-men'  are  the 
cancers." 

As  a  recent  quotation  has  shown,  Pasteur  himself,  with 
his  supreme  insight,  did  foresee  that  his  theory  of  molec- 
ular asymmetry  opened  up  a  new  horizon  for  physiology : 
that  in  it,  indeed,  as  Dr.  Beard  now  avers,  is  the  basis  of 
a  science  of  comparative  physiology.  Pasteur  was  not 
a  biologist  by  training,  and  he  was  not  acquainted  with 
the  researches  of  Hofmeister  and  others,  already  pub- 
lished, on  the  life-cycle  of  various  plants  and  their  alter- 
nation of  generations. 

"Now,"  says  Dr.  Beard,  "if  there  be  a  dextro-cellulose, 
or  a  Isevo-albumin,  or  a  dextro-sugar,  or  a  dextro-glyco- 
gen,  stereo-chemistry  asserts  the  possibility  or  the  neces- 
sity of  the  occurrence  of  a  Isevo-cellulose,  a  dextro-albu- 
min,  a  lasvo-sugar,  or  a  Isevo-glycogen.     This  the  reader 


98  THE  CONQUEST  OF  CANCER 

will  find  laid  down  on  p.  14  of  Meyerhoffer's  translation 
of  Van't  Hofif's  work.  As  Duclaux  quite  rightly  per- 
ceives, to  obtain  the  change  from  the  one  direction  of 
asymmetry  to  the  other,  it  is  necessary  to  go  back  to  the 
'germ.'  Like  the  cellulose  of  a  flowering-plant,  a  rose 
or  an  oak  tree,  that  of  the  fern-plant  is  dextro-cellulose. 
But  in  the  life-cycle  of  the  fern,  as  in  that  of  the  flower- 
ing plant,  there  are  two  generations,  the  asexual  one,  or 
fern-plant,  and  the  sexual  one,  the  small  and  insignificant 
prothallus.  As  the  cellulose  of  the  fern  is  dextro-cellu- 
lose, so  that  of  the  prothallus  must  be  Isvo-cellulose,  and 
so  with  the  other  naturally  occurring  organic  compounds. 
None  such  found  naturally  in  an  asexual  generation  of 
a  plant,  or  in  a  sexual  generation  of  an  animal,  will  be 
met  with  in  the  corresponding  sexual  generation  of  a 
plant  or  asexual  generation  of  an  animal ;  but,  if  oc- 
curring at  all,  it  will  be  represented  by  a  compound  with 
the  opposite  rotation." 

Elsewhere  I  discuss  the  specific  action  of  ferments, 
fitting  the  substance  upon  which  they  act  as  a  key  fits 
a  lock,  or  a  right  hand  a  right-hand  glove,  but  not  a  left- 
hand  glove  of  the  same  size  and  make.  The  ferments 
must  be  conceived  in  terms  of  stereo-chemistry  as  "solid" 
structures,  capable  of  interlocking  with,  and  acting  only 
upon,  substances  of  "opposite  isomeric  form." 

Now  the  cancer-ferment,  "malignin,"  as  we  know,  acts 
upon  and  pulls  down  the  Isevo-albumins  of  the  living 
human  body.  Per  contra,  trypsin,  as  has  been  repeatedly 
proved  by  Von  Leyden,  Blumenthal,  Bergell,  Pinkuss, 
Neuberg  and  Ascher  in  Germany  alone,  has  a  similar 
specific  action  upon  the  albumins  of  cancer.  Dr.  Beard, 
therefore,  suggests  that  the  specific  albumins  of  cancer 
' — the  existence  of  which  has  been  demonstrated  beyond 


THE  CHEMISTRY  OF  CANCER  99 

all  doubt  by  the  German  observers — must  be  dextro- 
rotatory. "As  the  Ijevo-albumins  of  the  living  human 
body  are  not  acted  upon  by  trypsin,  whereas  the  albumins 
of  a  living  cancer  are,  it  follows  .  .  .  that  the  latter 
must  be  dextro-albumins." 

Take  now  the  action  of  amylopsin.  This  ferment  read- 
ily converts  the  dextro-glycogen  of  the  liver,  but  has  no 
action  upon  the  glycogen  proper  to  cancer,  which  must 
therefore  be  a  Isevo-glycogen.^  The  use  of  amylopsin  in 
cancer  is  not  to  digest  its  glycogen  at  all. 

Says  Dr.  Beard :  "J^st  as  isomeric  compounds  in  the 
form  of  starches  occur  in  both  generations  of  plants,  so 
also  isomeric  compounds  of  glycogen  or  animal  starch 
are  found  in  sexual  and  asexual  generations  of  animals, 
including  cancer.  But  if  the  dextro-compound  occurs 
naturally  in  the  one  generation,  the  Isevo-  one  will  obtain 
in  the  other.  Mellor  remarks  that  only  the  dextro-sugars 
or  glucoses  are  known  to  occur  naturally.  This  is  because 
the  chemical  composition  of  the  sexual  generation  of  any 
plant — a  fern-prothallus,  for  example — has  never  yet 
been  determined  in  the  laboratory.  It  is  not  true  of 
animal  life,  for  as  long  ago  as  1859,  forty-eight  years 
ago,  Claude  Bernard  found  Isevulose,  or  Isevo-sugar,  in 
the  allantois.  According  to  him,  it  disappears  towards 
the  fifth  or  sixth  month  of  intra-uterine  life  of  the  calf, 
a  fact  that  goes  to  show  this  l^evo-sugar  to  be  formed  in 
the  trophoblast,  and  not  in  the  allantois.  Doubtless,  its 
disappearance  coincides  with  the  development  of  large 
numbers  of  leucocytes  in  the  foetus.  To  my  knowledge, 
this  laevo-sugar  has  more  recently  been  rediscovered  in 

'The  foetal  pancreas  produces  no  amylopsin.  Even  a  child  six 
months  old  cannot  digest  starch,  since  no  amylopsin  is  produced 
by  the  pancreas  until  after  the  first  year. 


100     THE  CONQUEST  OF  CANCER 

the  placenta,  but  I  am  not  aware  that  the  fact  has  been 
repubHshed.  Of  course,  the  allantois  and  the  placenta 
are  synonymous,  but  the  real  source  of  the  Isevulose  in 
both  instances  was  the  asexual  generation  or  tropho- 
blast."3 

The  antithetic  alternation  of  generations,  then,  de- 
pends upon  the  asymmetry  of  the  carbon  atom,  the  exist- 
ence of  isomers,  and  the  specific  and  antithetic  action  of 
the  ferments  which  can  act  upon  them. 

"With  the  start  of  the  sexual  or  the  asexual  phase  of 
the  cycle  the  naturally  occurring  compounds  are  built 
up  in  the  one  direction  or  in  the  other.  With  the  be- 
ginning of  the  next  phase  of  the  cycle — the  alternate 
one,  sexual  or  asexual — the  swing  of  the  pendulum  about 
the  asymmetrical  carbon  atom  is  on  the  other  side,  and 
the  naturally  occurring  organic  compounds  are  built  up 
in  the  opposite  direction.  In  animal  life,  that  of  the 
higher  animals,  the  compounds  are  built  up  after  the  fer- 
tilization of  the  egg  and  in  the  life-period  of  the  asexual 
generation  in  the  direction  of  Isevo-sugar,  laevo-glycogen 
and  dextro-albumins.  This  evolution  of  compounds  is 
the  antithesis  of  that  which  obtains  with  the  unfolding 
of  the  sexual  generation,  the  embryo  or  individual.  Here 
the  naturally  occurring  organic  compounds  are  evolved 
in  the  direction  of  dextro-sugars,  dextro-glycogen  and 
Isevo-albumins." 

Animals  and  plants  are  to  be  compared  in  this  respect. 
The  sexual  generation  of  animals  is  characterized  by 
dextro-sugars,  dextro-glycogen  and  Isevo-albumins.  In 
the  corresponding  sexual  generation  of  plants,  such  as 

°It  may  conceivably  be  relevant,  I  think,  to  observe  that  the 
breast,  a  very  common  site  of  cancer,  normally  produces  Isevulose, 
a  Isevo-sugar. 


THE  CHEMISTRY  OF  CANCER    101 

the  fern-prothallus,  these  are  absent,  being  replaced  by 
their  oppositely-rotating  isomers.  Thus  it  is  the  asexual 
generation  of  plants  (the  flowering-plant)  and  not  the 
sexual  generation,  as  in  animals,  which  possesses  dextro- 
sugar,  dextro-starch  and  dextro-albumins.  Observe  the 
planetary  significance  of  this. 

As  we  saw  in  the  last  chapter,  all  animals  depend  for 
their  food  upon  plants.  Says  Dr.  Beard:  "Were  th© 
sexual  generations  of  plants  the  produce  of  the  food- 
stuffs of  animals,  the  latter,  owing  to  the  insignificance 
of  the  former,  would  find  existence  a  very  serious  prob- 
lem. The  sexual  generations  of  plants  form  substances 
resembling  those  fabricated  by  the  asexual  generations 
of  animals,  trophoblast  or  cancer.  Even  if  obtainable  in 
■sufficiently  large  quantities,  the  substances  found  natu- 
rally in  a  cancer  would  not  be  suitable  as  the  foodstuffs 
of  an  animal — a  man,  for  example.  But  as  the  asexual 
mode  of  reproduction,  whether  of  a  plant  or  of  a  cancer, 
is  the  most  prolific  one,  there  has  hitherto,  at  all  events, 
been  no  failure  on  the  part  of  the  asexual  generations  of 
plants  to  furnish  ultimately  the  foodstuffs  of  the  animals. 
The  conditions  met  with  in  animals  are  reversed  in  plants. 
Here  a  la;vo-cellulose,  a  Isevo-sugar,  a  l^vo-starch,  and 
one  or  more  dextro-albumins  must  be  sought  for,  not  in 
the  asexual  generation  as  in  animals,  but  in  the  sexual 
one,  as  represented  by,  for  example,  the  fern-prothallus." 

The  matter  may  be  stated  in  the  following  table 
(Beard):— 


102  THE  CONQUEST  OF  CANCER 


ANIMAL 

Sexual  Generation  or  Indi-  Asexual    Generation    (fropho- 

vidual.  blast  or  cancer). 

Laevo-albumins,     not      acted  Dextro-albumins,    not    acted 

upon   when    living  by   trypsin,  upon  when  living  by  their  own 

but  attacked,  in  life  and  pulled  intra -cellular  ferment,  malignin, 

down    by    the    cancer-ferment,  but  attacked  in  life  by  trypsin, 

malignin.  Lsevo-sugar. 

Dextro-sugars.  Laevo-glycogen. 

Dextro-glycogen.  Pigment,     not     melanin     (in 

Pigment  melanin.  melano-sarcoma,     Blumen- 

thal). 

PLANT 

Asexual  Generation'  (flowering-  Sexual    Generation    {fern-pro- 
plant  or  fern).  thallus). 
Laevo-albumins.  Dextro-albumins. 
Dextro-starch.  Laevo-starch. 
Dextro-sugars.  Lasvo-sugars. 

One  more  quotation  from  Dr.  Beard  is  necessary : — 
"In  1889,  in  his  study  of  the  placentation  of  the  hedge- 
hog (Erinaceus  europccns),  Prof.  A.  A.  W.  Hubrecht 
set  up  the  term  trophoblast,  at  the  same  time  assigning  to 
it,  as  the  name  implies,  a  nutritive  significance.  The 
nutritive  import  of  the  trophoblast  of  normal  mammalian 
gestation  has  since  that  time  been  confirmed  by  many 
other  embryologists,  notably  by  E.  van  Beneden  and  M. 
Duval,  and  it  has  been  'generally  accepted.'  In  the  light 
of  our  present  knowledge  a  significance  different  from 
that  seen  in  it  by  Professor  Hubrecht  must  be  recognized 
in  'trophoblast.'  Trophoblast  has,  and  can  have,  no 
nutritive  import  for  the  developing  embryo.  This  is  quite 
obvious,  once  it  is  noted  that  the  natural  compounds 
formed  in  it  are  built  up  in  the  wrong  direction  to  be 


THE  CHEMISTRY  OF  CANCER    103 

useful  as  food  for  the  developing  sexual  organism.  The 
term,  therefore,  cannot  be  employed  in  future  in  a 
physiological  sense.  As  Duclaiix  said,  'Nature  alone 
knows  how  to  manufacture  the  one  isomer  without  pro- 
ducing the  other.'  The  chemist  in  the  laboratory  manu- 
factures equal  amounts  of  both  isomers.  May  one  deny 
nature  the  power  to  do  the  like  on  occasion?  Certainly 
not.  It  must  be  concluded,  that  in  the  fertilized  egg  she 
can  build  up  in  both  directions.  By  the  first  few  cleav- 
ages of  the  &gg,  usually  the  first  three  to  five,  she  can 
separate  off  portions  as  cells,  endowed  solely  with  the 
powers  of  producing  the  isomeric  compounds  of  tropho- 
blast,  whilst  retaining  for  the  cell  in  the  line  of  heredity 
the  property  of  forming  both.  With  the  start  of  the 
evolution  of  an  embryonic  body,  again  by  cell-di>ision, 
she  can  separate  off  one  or  more  original  embryonic  cells 
with  powers  opposite  to  those  possessed  by  trophoblast, 
all  this  taking  place  before  any  extra-cellular  enzymes, 
such  as  trypsin  and  amylopsin,  are  formed.  Full  agree- 
ment, therefore  (in  a  sense),  may  be  expressed  with  the 
conclusion  of  Duclaux.  that  'to  introduce  in  a  cell  prin- 
ciples immediately  diff'erent  and  the  inverse  of  those 
which  existed  there,  it  is  necessary  to  act  upon  it  at  the 
moment  when  it  is  most  plastic,  to  take  the  cell  of  the 
germ  and  try  to  modify  it'  (p.  66).  But  as  Duclaux  also 
observes,  this  cell  has  a  heredity,  and  these  determine  not 
only  its  being,  but  what  it  shall  become." 

I  believe  the  reader  will  agree  with  me  that  the  beauty 
of  this  final  theory  of  Dr.  Beard's  rivals  that  which  led 
him  to  indicate  trypsin  as  the  naturally  appointed  remedy 
for  cancer.  But  it  is  not  therefore  necessarily  true,  and 
it  is  here  submitted  as  a  hypothesis  for  consideration,  not 
for   acceptance.     We   must   remember   that,    as    Goethe 


104s  THE  CONQUEST  OF  CANCER 

said,  "Hypotheses  are  the  cradle  songs  with  which  the 
teacher  lulls  his  pupils  to  sleep." 

Some  less  general  aspects  of  the  chemistry  of  cancer 
will  be  considered  in  the  chapter  which  deals  with  the 
German  work  upon  this  subject,  but  here  I  reprint  for  the 
student  the  list  of  Dr.  Beard's  references  appended  to  the 
paper  of  which  this  chapter  is  a  summary. 


LITERATURE  CITED  IN  REFERENCE  TO  THE 
PRECEDING  CHAPTER 

Beard,  J.    The  Early  Development  of  Lepidosteus  osseus,  \xiProc. 
Roy.  Soc.  Loud.,  vol.  46,  pp.  108-118:  1889. 

The  History  of  a  Transient  Nervous  Apparatus  in  Cer- 
tain Ichthyopsida :  An  Account  of  the  Development 
and  Degeneration  of  Ganglion-Cells  and  Nerve- 
Fibres:  Part  I.,  Raja  batis,  in  Zool.  Jahrh.,  Morph. 
Abteil,  vol.  8,  pp.  1-106,  8  plates:  1896. 

On  Certain  Problems  of  Vertebrate  Embryology  (The 
Critical  Period,  etc.),  pp.  1-77:  Jena,  Gustav  Fischer, 
1896. 

The  Span  of  Gestation  and  the  Cause  of  Birth,  pp.  vi  and 
132 :  Jena,  Gustav  Fischer,  1897. 

Embryological  Aspects  and  Etiology  of  Carcinoma,  in  the 
Lancet,  June  15,  1902. 

A  Morphological  Continuity  of  Germ-Cells  as  the  basis  of 
Heredity  and  Variation,  in  Rev.  Neiir.  Psych.,  1904. 

The  Cancer-Problem,  in  the  Lancet,  Feb.  4,  1905. 

The  Interlude  of  Cancer,  in  Medical  Record,  Feb.  2,  1907 : 
New  York. 

The  Scientific  Criterion  of  a  Malignant  Tumor,  in  Medi- 
cal Record,  Jan.  5,  1907 :  New  York. 
Bergell,   p.     Zur  Chemie  der  Krebsgeschwiilste,  in  Zeitschr.  f. 

Krebsforschung,  vol.  5,  pp.  204-208 :  1907. 
Bernard,  Claude.    Lecons  de  Physiologie  experimentale,  vol.  I : 
1853,  Paris. 


THE  CHEMISTRY  OF  CANCER    105 

Blumenthal,  F.  Die  chemische  Abartung  der  Zellen  beim 
Krebs.,  in  Zeitschr.  f.  Krebsforschung,  vol.  5,  pp. 
182-189:  1907. 
Die  chemische  Vorgiinge  bei  der  Krebskrankheit,  in 
Ergebn.  d.  Exper.  Path.  u.  Therap.,  vol.  i,  pp.  65-104 : 
1907. 

Cleaves,  M.  A.  The  Physiological  Action  of  the  Pancreatic 
Enzymes,  with  special  reference  to  Hematology, 
Urinology,  and  Qinical  Pathology,  in  Medical  Rec- 
ord, June  I,  1907 :  New  York. 

CoRViSAET,  LuciEN.  Sur  une  Fonction  pen  connue  du  Pancreas, 
pp.  1-123:  Paris,  1857-8. 

DucLAUx,  E.  Pasteur:  Histoire  d'un  Esprit,  pp.  i-vii  and  1-393: 
Paris,  1896. 

HoFMEiSTER,  WiLHELM.     Vergleichende  Untersuchungen  :  1851. 

HuBRECHT,  A.  A.  W.  The  Placentation  of  Erinaceus  europaeus, 
in  Quart.  Jour.  Micros.  Sci.,  vol.  30,  pp.  283-404,  13 
plates :  1889. 

KiJHNE,  WiLHELM.  Ueber  das  Verhalten  verschiedener  organi- 
sirter  und  sog.  ungeformter  Fermente,  and  Ueber  das 
Trypsin  (Enzym  des  Pankreas),  in  Verhandl.  des 
Heidelb.  Naturhist.  Med.  Vercins.,  N.S.  I.  3,  pp.  i-io: 
1876. 

Leyden,  E.  von,  u.  Bergell,  p.    Ueber  die  therapeutische  Anwen- 

dung  von  Pancreatin  in  Carcinoma,  in  Zeitschr.  f. 

klin.  Med.,  vol.  61,  pp.  360-365  :  1907. 
Mellor,  J.  W.    Chemical  Statics  and  Dynamics :  London,  1904. 
Pasteur,  Louis.     De  la  dissymmetrie  moleculaire  des  produits 

organiques  naturels.     Legon  professee  devant  la  So- 

ciete  chimique,  i860. 
Pope,    William    J.      Recent    Advances    in    Stereo-Chemistry,    in 

Nature,  vol.  68,  pp.  280-283 :  1903. 

Rice,  Clarence  C.  Treatment  of  Cancer  of  the  Larynx  by  sub- 
cutaneous injection  of  Pancreatic  Extract  (Trypsin), 
in  Medical  Record,  Nov.  24,  1906,  pp.  812-816:  1906, 
New  York. 

Sachs,  Julius  von.    Geschichte  der  Botanik :  Munchen,  1875. 


106     THE  CONQUEST  OF  CANCER 

WiGGiN,  F.  H.  Case  of  Multiple  Fibrosarcoma  of  the  Tongue,  in 
Jour.  Amer.  Med.  Assoc,  Dec.  15,  1906,  pp.  2003-2008. 

RiCHARDSOK,  G.  M.  The  Foundations  of  Stereo-Chemistry,  Me- 
moirs by  Pasteur,  Van't  Hoff,  Lebel,  nx.  Wislicenus. 
Translated  and  edited;  New  York,  1901. 

Hoff,  J.  H.  Stereo-chemie.  Nach  Van't  Hoff's  Dix  annees  dans 
I'histoire  d'une  theorie  neu  bearbeitet  von  W.  Meyer- 
hoffer:  1892. 

Wedekind^  Edgar.  Zur  Stereo-chemie  des  funfwertigen  Stick- 
stofifes :  Leipzig,  1899. 

Vallery-Radot,  Rene.    La  Vie  de  Pasteur :  Paris,  1901. 


PART  II— PRACTICAL 


CHAPTER  XI 

CANCER    AND    SURGERY 

Until  the  recent  inquiries  which  this  book  discusses, 
it  was  generally  recognized  that,  despite  all  other  prom- 
ises, there  was  no  means  of  opposing  the  growth  of  cancer 
but  the  knife.  The  local  treatment,  whether  by  the  knife 
or  caustics,  of  what  is  at  first  a  local  disease  in  every 
case,  dates  back  to  the  earliest  times.  At  one  period  dur- 
ing the  nineteenth  century  the  view  was  strongly  ex- 
pressed, and  held,  that  though  the  manifestations  of  ma- 
lignant disease  are  primarily  local,  the  malady  really  has 
its  seat  in  the  blood,  and  that  therefore  all  local  treat- 
ment is  essentially  futile.  Now  it  may  very  probably  be 
true  that  certain  conditions  of  the  blood  are  highly  rele- 
vant to  the  growth  of  cancer,  but  no  one  would  as  yet  again 
oppose  the  surgical  treatment  of  cancer  on  the  grounds 
which  were  formerly  maintained.  For  many  years  past, 
and,  indeed,  ever  since  the  immortal  work  of  Lister  made 
possible  the  scientific  development  of  surgery,  such  ad- 
vance as  has  been  achieved  in  the  treatment  of  cancer  has 
been  entirely  surgical.  The  solitary  exception,  perhaps, . 
is  that  of  the  treatment  by  the  Rontgen  rays  of  the  most 
superficial  and  least  malignant  form  of  cancer,  which  is 
known  as  rodent  ulcer.  The  surgeons  and  the  patholo- 
gists have  joined  hands  to  ascertain,  in  the  case  of  cancer 
occurring  in  various  sites,  the  directions  in  which  the 
disease    commonly    spreads,    and    the    position    of    the 

109 


110     THE  CONQUEST  OF  CANCER 

lymphatic  glands  in  which  secondary  growths  commonly 
occur.  These  investigations  have  led  to  the  devising  and 
making  of  ever  more  and  more  extensive  operations. 
Not  so  very  long  ago,  for  instance,  the  surgeon  was  con- 
tent merely  to  excise  visible  cancer  of  the  tongue  or  lip ; 
now,  in  addition  to  doing  so,  he  systematically  removes 
all  the  neighboring  lymphatic  glands,  whether  they  be 
obviously  enlarged  or  not.  Similarly,  time  was  when, 
for  cancer  of  the  breast,  that  organ  alone  was  removed, 
but  for  some  few  years  past  no  surgeon  would  be  regard- 
ed as  competent  or  conscientious  who  did  not  completely 
clear  out  all  the  lymphatic  glands  in  the  arm-pit  and  above 
the  collar-bone  of  the  affected  side.  In  later  years  much 
more  radical  operations  for  cancer  of  the  breast  have 
been  carried  out,  even  to  the  extent  of  removing  a  great 
deal  of  the  muscular  tissue  underneath  the  organ. 

The  surgeons,  however,  have  had  to  fight  against  diffi- 
culties perhaps  more  serious  even  than  those  inherent 
in  the  nature  of  the  disease  itself.  These  difficulties  may 
be  summed  up  as  fear  and  ignorance  on  the  part  of  the 
patient,  and  ignorance  on  the  part  of  the  doctor.  This 
latter  difficulty  has  been  very  largely  disposed  of  in  later 
years.  Enormous  improvement  has  taken  place  in  the 
early  diagnosis  of  cancer,  as  well  as  in  its  diagnosis  at 
all  stages,  and  it  is  this  increased  recognition  of  the  dis- 
ease that  probably  accounts  for  the  apparent  increase  in 
its  occurrence.  I  am  not  acquainted  with  any  conclusive 
evidence  which  shows  that  the  incidence  of  the  disease  is 
actually  increasing.  When  this  difficulty  is  removed,  how- 
ever, there  remains  the  fear  and  the  ignorance  of  the  pa- 
tient, and  lately  efforts  have  been  made  in  Germany  and  in 
this  country  to  combat  this  state  of  things.  The  German 
efforts  mainly  took  the  form  of  a  newspaper  crusade. 


CANCER  AND  SURGERY  111 

designed  to  warn  women  of  the  necessity  for  inquiring 
closely  into  certain  symptoms  occurring  at  certain  ages, 
which  they  too  often  disregard.  The  hope  was  that  thus 
many  early  cases  would  come  up  for  treatment  when  the 
surgeon  might  reasonably  hope  for  substantial  results 
from  his  interference;  and  this  expectation  has  appar- 
ently been  justified  in  some  measure. 

Now,  though  this  volume  constitutes,  as  I  believe,  a 
most  serious  portent  for  the  surgeons  from  the  financial 
point  of  view,  it  is  well  to  have  it  clearly  understood 
that  the  writer  has  no  bias  whatever  against  surgery 
or  surgeons,  or  the  surgical  treatment  of  cancer.  On 
the  contrary,  until  these  new  discoveries,  I  was  most 
firmly  convinced  of  the  importance  of  surgery  as  the 
only  hope  for  the  victim  of  cancer,  and  fortunately  I  can 
prove  that  it  was  my  desire  to  aid  the  surgeons  as  far 
as  might  be  in  their  struggle  against  this  disease.  In 
addition,  therefore,  to  many  published  statements  of  mine 
on  this  point,  I  asked  a  distinguished  English  surgeon 
to  contribute  to  The  Nezv  Library  of  Medicine,  of  which 
I  am  the  editor,  a  volume  which  should  discuss  the 
duty  of  the  public  to  itself  in  respect  of  the  recogni- 
tion of  cancer  at  stages  which  the  surgeon  may  hope  to 
control.  I  shall  here  avail  myself  of  certain  facts  cited 
in  that  volume^ — facts  which  retain  their  importance 
despite  all  present  or  subsequent  developments  in  the 
non-surgical  treatment  of  cancer.  We  must  remind  our- 
selves that  the  importance  of  early  treatment,  in  any 
case,  can  scarcely  be  overestimated.  Nothing  could  he 
more  disastrous  than  the  creation  of  a  belief  that  it  does 

^The  Control  of  a  Scourge;  or,  How  Cancer  is  Curable.  By 
C.  P.  Childe,  B.A.,  F.R.C.S.  The  New  Library  of  Medicine: 
Messrs.  Methuen  &;  Co.  - 


11^  THE  CONQUEST  OF  CANXER 

not  iiozi'  liiafter  at  zvhat  stage  cancer  is  treated — the  be- 
lief that  the  ferments  can  be  trusted  at  any  stage,  or  that 
it  does  not  matter  when  the  knife  is  em.ployed  now  that 
it  has  the  ferm.ents  to  help  it.  We.  have  to  remember 
that,  just  as  tuberculosis  destroys  lung-tissue,  which  no 
conceivable  treatm.ent  can  re-create,  just  as  the  most 
trivial  cut  in  the  skin,  though  it  heals  in  a  couple  of  days, 
involves  the  permanent  destruction  of  cutaneous  struc- 
tures, so  the  growth  of  malignant  tissue  involves  a  de- 
struction of  healthy  tissues,  which  no  treatment,  though 
it  v.-ere  instantaneous  and  absolute,  can  conceivably  re- 
store. Assuredly,  it  remains  of  the  greatest  importance 
that  cancer  be  recognized  early,  but  on  account  of  the 
damage  v.hich  it  causes,  the  pain  involved  in  its  growth, 
and  the  length  of  tim.e  which  vrill  be  necessary  for  treat- 
ment. 

The  great  surgeon.  Sir  Benjamin  Brodie.  after  oper- 
ating on  not  far  short  of  six  hundred  cases  of  cancer 
of  the  breast,  "came  to  the  conclusion  that  life  was  rather 
shortened  than  prolonged  by  his  efforts  in  this  direction, 
and  decided  never  to  remove  another  breast  for  cancer 
without  first  laying  before  the  patient  his  experience  of 
its  results."  In  his  lectures  on  Surgical  Pathology-,  Sir 
James  Paget  said :  "I  will  not  say  such  a  thing  as  cure 
is  impossible,  but  it  is  so  highly  im.probable  that  a  hope 
of  this  occurring  in  any  single  instance  cannot  be  reason- 
ably entertained."  The  results  of  recent  surgery,  how- 
every,  are  xtvy  different,  and  if  we  accept  what  is  called 
the  three  years'  limit  we  shall  find  that  m.any  cures  may 
now  be  obtained.  This  three  years'  limit  is,  of  course,  an 
entirely  arbitran,-  one,  and  it  is  certainly  not  possible  to 
say  that  a  cancer,  if  it  is  to  recur  at  all.  alwavs  recurs 
within   that   limit;   but   the   figure   is   of   iorr.t   practical 


CANCER  AND  SURGERY  113 

utility.^  We  may  note  in  passing  the  absurdity  of  the 
argument  which  has  been  advanced  against  some  of  the 
reported  cures  by  the  pancreatic  treatment,  that  no  men- 
tion should  be  made  of  any  results  until  three  years  have 
expired :  as  if  this  three  years'  limit  were  a  law  of  nature. 
It  almost  beggars  belief  that  any  one  should  apply  the 
same  criterion  to  the  disappearance  of  an  active  tumor 
under  hypodermic  injections,  as  to  excision  by  the  knife. 
The  reader  may  be  referred  to  Mr.  Childe  for  recent 
statistics  which  show  that  adequate  operation  in  early 
cancer  sometimes  effects  real  cures.  I,  for  one,  have  no 
desire  to  underrate  this  fact,  nor  to  deny  great  credit  to 
the  surgeons  for  their  efforts. 

The  chief  difficulty  of  the  surgeons  I  have  asserted 
to  be  the  lateness  of  most  operations.  Mr.  Childe  very 
clearly  shows  how  women,  aware  of  a  lump  in  the  breast, 
will  delay  for  periods — sometimes  of  months,  sometimes 
as  many  as  two,  three  or  five  years — before  they  seek 
advice.  On  the  other  hand,  when  the  surgeon  has  a  fair 
chance,  he  may  undoubtedly  succeed  in  effecting  true 
cures  of  cancer.  One  distinguished  surgeon,  for  instance, 
quoted  by  Mr.  Childe,  says,  "I  am  strongly  of  opinion 
that  lip  cancer  seldom  returns  if  operated  on  thoroughly 
and  sufficiently  early."  All  the  surgical  authorities  are 
agreed  that  "the  elimination  of  this  disastrous  factor, 
delay,"  would  make  an  enormous  difference  in  the  surgi- 
cal treatment  of  cancer. 

In  the  endeavor  to  present  an  absolutely  impartial  state- 
ment of  the  facts,  however,  we  have  to  recognize  another 
side  of  this  question.  Believing,  as  we  must,  that  the 
cancerous  tissue  is  of  a  specific  kind,  and  has  a  specific 

'It  has  recently  been  shown  that  the  disease  recurs  in  at  least  one- 
fourth  of  those  who  are  called  cured  at  the  end  of  three  years. 


lU  THE  CONQUEST  OF  CANCER 

origin,  we  need  not  question  that  if  the  surgeon  succeeds 
in  removing  the  whole  of  it,  there  will  be  no  recurrence 
of  the  disease.  AVe  may  also  incline  strongly  to  the  view 
that  the  explanation  of  recurrence,  when  it  occurs,  is  to 
be  sought  in  the  inadequacy  of  the  removal.  Surgeons 
have  often  asked  whether  this  was  the  explanation  or 
whether  the  disease  simply  made  a  fresh  start  in  the 
neighborhood.  All  the  surgical  evidence  goes  to  show 
that  this  last  is  not  the  explanation,  and  Dr.  Beard's 
theory  of  the  nature  of  cancer  points  in  the  same  direc- 
tion. On  that  theory  a  recurrence  after  complete  re- 
moval would  not  be,  properly  speaking,  a  recurrence  at 
all,  but  the  malignant  development  of  a  new  germ-cell 
which  happened  to  be  in  the  neighborhood,  and  which 
found  conditions  favorable  to  its  multiplication.  Such 
a  coincidence  would  be  extremely  improbable.  But  we 
have  to  reckon  with  the  fact  that  in  the  vast  majority  of 
cases  the  surgeon  does  not  remove  the  whole  of  the  ma- 
lignant tissue.  He  removes  part,  very  likely  the  greater 
part,  but  he  leaves  some  of  it,  and  that,  by  his  interfer- 
ence, he  may  possibly  affect.  His  knife  cuts  through  it. 
It  is  very  possibly  exposed  to  the  action  of  antiseptics, 
and  in  some  cases,  doubtless,  these  may  be  so  powerful  as 
actually  to  kill  a  certain  number  of  cancer-cells  together 
with  the  normal  cells  of  the  tissues  surrounding  them.  But 
what  will  be  the  eftect  of  these  injurious  influences  upon 
the  cancer-cells  which  are  neither  removed  nor  killed  ? 

In  seeking  to  answer  this  question  we  must  reckon 
in  the  first  place,  with  a  large  number  of  clinical  facts, 
and  for  certain  of  these  I  am  indebted  to  a  recent  vol- 
ume^ by  Dr.  John  Shaw,  himself  formerly  a  distinguished 

^The  Cure  of  Cancer,  and  How  Surgery  Blocks  the  Way.  By 
John  Shaw,  M.D.  (London).    F.  S.  Turney.     1907. 


CANCER  AND  SURGERY  115 

surgical  operator.  There  is  much  evidence  to  show  that 
when  cancer  recurs  after  operation,  it  is  apt  to  grow 
more  rapidly  and  to  show  more  malignancy  than  before. 
In  recent  years,  the  increment  of  mortality  from  cancer 
has  been  enormous,  notwithstanding  the  very  great  ex- 
tension of  surgical  activity  against  this  disease.  Now, 
Sir  James  Paget,  a  generation  ago,  in  his  famous  lectures 
on  Surgical  Pathology,  comments  upon  cases  in  which 
a  tumor,  apparently  innocent,  is  removed,  but  some  time 
after  a  cancer  appears  at  the  same  part.  He  suggests 
that  "in  the  removal  of  this  tumor,  the  surgeon  has 
unwittingly  supplied  by  the  local  injury  what  was  needed 
for  the  production  of  a  cancerous  growth:  he  has  made 
some  locality  apt  for  the  manifestation  of  a  constitutional 
disease  already  existing."  Now,  without  unreservedly 
accepting  the  definition  of  cancer  as  a  constitutional  dis- 
ease, we  may  note  the  suggestion  by  this  great  man,  whose 
pathological  insight  amounted  to  absolute  genius,  that  the 
local  injury  involved  in  operation  may,  in  effect,  constitute 
a  stimulus  towards  the  development  of  cancer.  Elsewhere 
in  the  same  famous  volume  Paget  says :  "A  tumor  which 
at  first  might  be  not  unlike  the  normal  fibrous  or  glandular 
texture  in  which  it  grew,  after  repeated  removal  and  re- 
currences becomes  softer,  more  succulent,  and  in  its  later 
growths  may  seem  to  the  naked  eye  little  more  than  like 
masses  of  yellow  or  ruddy  soft  gelatine  with  blood-vessels. 
The  latter  are  usually  much  more  rapid  in  their  progress ' 
than  the  earlier  growths,  they  are  generally  less  well 
defined,  penetrating  farther  and  more  vaguely  among 
the  interstices  of  adjacent  parts,  and  more  quickly  pro- 
truding through  the  skin  or  scars  over  them.  And  in 
these  characters  the  later-formed  tumors  assume  more  of 
the  character  of  malignancy  than  the  earlier.    ...    In 


116     THE  CONQUEST  OF  CANCER 

one  of  Prof.  Gluge's  cases  the  transitions  to  completely 
malignant  characters  appeared  yet  more  sure.  Mr. 
Syme  also  expresses  a  similar  transition ;  describing  as  the 
usual  course  of  the  cases  he  has  seen,  that,  after  one  or 
two  recurrences  of  the  tumor,  the  next  new  productions 
present  a  new  degeneration  of  character,  excite  pain, 
proceed  to  fungous  ulceration,  and  thus  in  the  end  prove 
fatal.  So  that,  although  there  be  cases  in  which  this  evil 
career  has  not  been  run,  yet  I  think  we  may  regard  these 
tumors  as  approximating  to  characters  of  malignancy, 
not  only  in  their  proneness  to  recurrence  after  removal, 
but  in  their  aptness  to  assume  more  malignant  features 
the  more  often  they  recur.  Whatever  be  the  truth  con- 
cerning the  supposed  transformation  of  an  innocent  into 
a  malignant  morbid  growth,  I  think  it  can  hardly  be 
doubted  that,  in  the  cases  of  some  recurring  tumors,  the 
successively  later  growths  acquire  more  and  more  of  the 
characters  of  thoroughly  malignant  disease."  Note  also 
the  statement  of  Prof.  Godlee  regarding  a  certain  kind 
of  malignant  tumor  that  "Sarcomata  present  all  degrees 
of  malignancy ;  but,  as  a  rough  rule,  it  may  be  stated  that 
the  higher  the  degree  of  development  of  the  tumor,  the 
less  likely  is  recurrence  to  take  place  after  removal.  In 
connection  with  this  point,  it  is  interesting  to  note  that 
each  recurrence  of  a  sarcoma  often  shows  a  more  rudi- 
mentary structure,  and,  at  the  same  time,  a  greater  degree 
of  malignancy." 

Closely  allied,  as  we  may  see,  to  the  facts  above  quoted, 
are  certain  consequences  which  may  sometimes  follow 
the  practice  of  removing  a  small  portion  of  a  tumor  for 
purposes  of  microscopical  examination.  In  such  cases 
it  has  sometimes  happened  that  the  tumor,  after  the  per- 
formance of  what  is  practically  a  very  inadequate  opera- 


CANCER  AND  SURGERY  117 

tion  for  removal,  shows  rapid  growth.  Dr.  Shaw's  con- 
clusion from  the  evidence  which  he  adduces  runs  thus : 
''On  the  evidence  already  presented,  I  submit  that  the 
conclusion  is  incontrovertible,  that  operation  may  induce 
malignancy  in  structures  which  beforehand  were  devoid 
of  all  such  characteristics."  The  experimental  evidence 
regarding  the  behavior  of  cancer  in  mice  strongly  con- 
firms this  opinion,  and  though  I  cannot  assent  to  Dr. 
Shaw's  explanation  of  the  facts,  I  believe  that  the  facts 
are  established.  Every  one  recognizes,  the  surgeons  in- 
cluded, that  irritation  may  excite  cancerous  growth,  and 
in  the  case  of  warts  upon  the  face,  for  instance,  the  sur- 
geon always  discourages  the  application  of  caustics  for 
fear  of  this  consequence.  But  it  is  evident  when  we 
come  to  consider  the  matter  that  the  performance  of  an 
imperfect  operation  for  cancer  involves  the  application 
of  very  serious  irritation  to  the  living  cancer-cells  which 
'are  not  removed,  and  the  irritation  which  will  arouse  a 
cancerous  growth  from  its  germ  may  reasonably  be  ex- 
pected to  increase  the  vitality  of  a  growth  already  present. 
I  am  not  aware  that  any  surgeon  has  made  this  obvious 
observation. 

If  now  we  turn  to  the  Zeitschrift  fiir  klinische  Medi- 
sin,  vol.  6i,  pp.  360-365,  1907,  we  find  the  greatest  official 
authority  upon  cancer  in  the  whole  world.  Prof.  Ernst 
Von  Leyden,  laying  down  a  great  principle  regarding 
the  growth  of  cancer.  It  is  that  malignant  tissue  in 
general  is  characterized  by  the  response  of  increased 
growth  in  consequence  of  all  forms  of  injury,  whether 
mechanical,  chemical  or  thermal.  This  is  not  to  say,  of 
course,  that  injury  will  not  kill  malignant  cells,  but  that 
the  cells  w^hich  are  not  killed  (or  removed,  as  by  the 
knife)  will  tend  to  grow  not  less  but  more  in  consequence 


118     THE  CONQUEST  OF  CANCEK 

of  the  injury.  In  short,  they  respond  to  the  irritation; 
of  the  injury,  just  as  the  cells  of  a  pigmented  mole  may 
respond  to  the  application  of  caustics.  This  principle, 
subscribed  to  by  Von  Leyden,  is  in  entire  accordance 
with  the  clinical  facts  which  we  have  lately  been  consid- 
ering. It  constitutes  a  general  expression  of  such  facts 
as  the  accelerated  growth  of  a  recurrent  tumor  and  the 
more  malignant  type  which  such  a  tumor  displays,  both 
as  regards  its  behavior  and  as  regards  its  microscopic 
structure.  Here  I  may  note — though  it  is  not  our  imme- 
diate concern — that  after  his  work  with  trypsin,  Von 
Leyden  declares  himself  to  have  recognized  a  new  fact. 
He  found  that  trypsin  acted  as  an  injurious  agent  upon 
cancerous  tissue  in  the  body,  as  was  proved  by  its  actual 
dissolution  of  such  malignant  cells  as  were  exposed  to  it. 
But  he  never  found  that  this  injurious  action  was  sub- 
sequently responded  to  by  increased  growth,  either  locally 
or  generally,  on  the  part  of  the  remaining  cells.  This, 
as  Von  Leyden  recognizes,  is  a  new  and  a  unique  fact, 
constituting  the  only  exception  to  the  principle  of  in- 
creased growth  after  injury  which  has  already  been  laid 
down. 

This  principle  of  increased  growth  and  malignancy 
has  to  be  reckoned  with  by  the  surgeon,  and  it  is  of 
interest  to  observe  that  its  operation  may  be  recognized, 
even  in  the  case  of  the  one  other  influence  which,  besides 
trypsin,  seems  to  have  a  specific  injurious  action  upon 
malignant  cells.  This  is  the  case  of  the  Rontgen  rays, 
and  of  radium,  acting,  as  I  surmise,  by  means  of  its 
gamma  radiation,  which  is  essentially  the  same  as  the 
Rontgen  rays.  Here  there  would  seem  to  be  a  specific 
action  upon  malignant  tissue,  but  in  the  overwhelming 
majority  of  cases  where  this  action  does  not  amount  to 


CANCER  AND  SURGERY  119 

the  complete  destruction  of  all  the  offending  cells,  the 
principle  of  increased  growth  after  injury  may  be  mani- 
fested. Unfortunately  also  there  is  evidence  that  the 
Rontgen  rays  may  actually  excite  malignant  growth  de 
nova  in  certain  cases.  Trypsin,  therefore,  and  possibly 
other  ferments,  are  alone  in  their  relation  to  this  principle. 

How,  then,  do  these  facts  bear  upon  surgical  practice 
at  the  present  day,  so  far  as  malignant  disease  is  con- 
cerned? 

In  the  first  place,  I  do  not  make  any  suggestion  or 
proposal  that  complete  surgical  operation,  when  prac- 
ticable, should  not  be  employed  for  cancer.  Though  in- 
adequate operations  certainly  stimulate  the  growth  in 
accordance  with  the  law  laid  down  by  Prof.  Von  Leyden, 
we  now  have  means  which  may  neutralize  that  stimula- 
tion, while  operations  on  early  cases,  removing  the  whole 
disease,  are  often  now-a-days  completely  successful.  I 
believe  the  time  will  come  when  the  knife  may  be  dis- 
carded for  the  cancrotoxic  ferments,  but  it  has  not  yet 
come.  I  desire  nothing  less  than  to  dissuade  patients  at 
this  stage  from  availing  themselves  of  all  the  real  help 
that  the  surgeon  can  give  them.  It  may  be  clearly  recog- 
nized that  in  early  and  suitable  cases  modern  surgery  may 
remove  the  whole  disease  finally  without  any  appreciable 
risk,  and  with  a  rapidity  which  no  other  mode  of  treat- 
ment can  emulate.  Furthermore,  there  are  other  cases  of 
advanced  internal  cancer  in  which  surgery  can  perform 
what  are  called  plastic  operations,  that  go  some  way 
towards  compensating  for  damage  which  has  already 
been  done  by  the  disease,  and  which  no  conceivable  treat- 
ment can  make  good.  In  the  present  state  of  things, 
then,  the  surgeon's  help  is  by  no  means  to  be  dispensed 
with. 


120     THE  CONQUEST  OF  CANCER 

But  no  matter  how  early  the  case  or  how  radical  the 
operation,  trypsin  and  amylopsin,  or  more  effective  fer- 
ments, if  such  exist,  should  also  be  employed  from  the 
first,  and  no  less  vigorously  after  the  operation  than  be- 
fore it,  in  order  to  avert  the  recurrence  which  follows  the 
overwhelming  majority  of  even  the  most  extensive  opera- 
tions. I  honor  the  surgeon,  unknown  to  me,  who  wrote 
a  column-long  letter,  signed  "F.  R.  C.  S.,"  to  the  Morn- 
ing Post  (April  i6,  1907),  extolling  the  use  of  trypsin 
in  cancer,  for  his  public  advocacy  of  a  mode  of  treatment 
which  may  prove  to  be  the  most  serious  matter  financially 
to  the  surgical  profession ;  but  meanwhile  the  surgeons 
also  may  benefit  as  regards  reputation  and  results,  if  they 
will  use  these  remedies  in  addition  to  the  knife.  It  can- 
not possibly  be  doubted  that  a  successful  non-surgical 
method  of  treating  malignant  disease  must  constitute  a 
serious  menace  to  the  pockets  of  operating  surgeons. 
This  obvious  assertion  has  been  questioned.  It  has  been 
truly  said  "the  profession  can  only  gain  by  any  increase 
of  its  resources  against  disease,"  and  that  is  certainly 
true  in  the  great  sense;  but  the  fact  certainly  remains, 
that  if  operations  for  cancer  were  to  become  unknown, 
the  surgeons  would  find  a  very  large  part  of  their  occcu- 
pation  gone.  The  utmost  honor  is  therefore  due  to  the 
one  or  two  surgeons  who  have  seriously  looked  into  the 
new  principle  of  treatment,  and  it  is  earnestly  to  be 
hoped  that  they  may  have  their  reward.  At  the  time  of 
writing  I  know  of  one  such  in  America,  the  writer  of  the 
Morning  Post  letter,  and  one  other  in  Great  Britain,  and 
Prof.  Bier  in  Germany. 

On  further  consideration  I  see,  however,  that  it  will 
not  do  to  leave  the  question  thus.     As  Dr.  Hale  White 


CANCER  AND  SURGERY  121 

pointed  out  in  the  "Address  in  Medicine"  delivered  be- 
fore the  British  Medical  Association  at  Exeter,  in  Au- 
gust, 1907,  it  is  a  source  of  the  gravest  error  to  act  in 
practice  upon  the  results  obtained  by  the  most  skilful 
surgeons.  Take  the  common  instances  of  cancer  of  the 
breast  or  tongue.  The  surgeons  throughout  the  world 
at  the  present  day  who  perform  really  adequate  opera- 
tions in  such  cases,  even  when  they  are  taken  in  time, 
certainly  do  not  run  into  three  figures.  Only  one  patient 
in  many  thousands  is  fortunate  enough  to  come  under 
their  hands.  The  adequate  operation  for  cancer  is  the 
excessively  rare  exception.  It  is  right  that  the  results 
thus  obtained  should  be  published  and  the  obvious  argu- 
ment drawn  from  them,  as  is  done  by  Mr.  Childe,  but  it 
is  grossly  fallacious  to  assume  that  these  results  might 
and  would  be  attained  everywhere  if  patients  would  come 
up  for  operation  in  time.  To  the  British  Medical  Journal 
(July  20,  1907)  Mr.  Childe  himself  contributed  an  article, 
entitled  "The  Educational  Aspect  of  the  Cancer  Ques- 
tion," which  abundantly  demonstrates  the  need  for  edu- 
cating not  only  the  public  but  also  the  generality  of 
surgeons.  He  lays  down  the  proposition,  which  will  be 
generally  accepted,  that  "every  recurrence  is  owing  to 
omission  on  the  part  of  the  surgeon  to  overtake  the  cen- 
trifugally  spreading  disease."  Now  recurrence  is  the  all 
but  invariable  rule,  if  the  whole  of  surgery  for  cancer 
be  reviewed,  and  not  merely  the  work  of,  say,  two  sur- 
geons in  one  capital  and  one  in  another.  Furthermore, 
even  the  most  accomplished  surgeons  have  a  large  per- 
centage of  failures,  despite  the  fact  that  the  modern  radi- 
cal operations  have  now  reached  something  like  the 
utmost  limit  of  the  practicable.  Now  it  is  necessary, 
plainly,  not  to  write  as  if  every  surgeon  were  a  past- 


122     THE  CONQUEST  OF  CANCER 

master  and  as  if  every  patient  applied  for  treatment  at 
the  earliest  possible  stage.  These  conditions  are  highly 
desirable,  but  they  are  not  actual,  and  the  actual  is  our 
concern  here. 

In  the  light  of  the  clinical  facts  above  recorded  as  to 
the  increased  malignancy  of  growths  recurrent  after 
operation,  and  the  law  laid  down  by  Von  Leyden,  it  is 
necessary  to  question  very  gravely  the  assumption  that 
even  imperfect  operations — that  is  to  say,  practically  all 
operations — at  any  rate  may  and  usually  do  lengthen  life. 
The  probability  would  seem  to  be,  on  the  contrary,  that 
they  shorten  it.  There  is  absolutely  no  evidence  to  show 
that  the  usual  series  of  operations  do  lengthen  life,  and 
the  probability  is  all  the  other  way.  Hence  the  difference 
between  a  perfect  operation,  that  extreme  rarity,  and  an 
imperfect  one,  is  not  merely  one  of  degree — that  the 
patient  dies  of  some  other  disease  in  the  one  case,  and 
that  his  life  is  at  least  somewhat  prolonged  in  the  other. 
The  truth  probably  is  that  the  one  operation  lengthens 
life  and  the  other  shortens  it:  and  very  nearly  all  opera- 
tions belong  to  the  latter  category.  Mr.  Childe  tells  us 
that,  during  the  last  seventeen  years  of  his  career,  the 
surgeon  Benedikt,  of  Breslau,  gave  up  operating  alto- 
gether in  cancer  of  the  breast,  and  the  opinion  of  Sir 
Benjamin  Brodie  has  already  been  quoted.  These  be- 
long to  a  past  generation,  and  the  same  surgeons,  oper- 
ating now,  would  doubtless  obtain  different  results,  be- 
cause a  certain  number  of  their  operations  would  be 
really  adequate.  But  the  overwhelming  majority  of 
operations  now  performed  are  essentially  of  the  character 
of  those  performed  by  Brodie,  and  the  probability  is  that 
their  results  are  substantially  the  same  as  his — they  do 
not  even  lengthen  life,  but  shorten  it. 


CANCER  AND  SURGERY  |123 

Thus  it  seems  probable  that  the  only  surgical  operation 
which  can  really  be  commended  to-day  is  the  perfect 
one,  which  removes  the  whole  of  the  disease;  and  this 
leads  us,  quite  apart  from  any  question  of  trypsin,  to  the 
formidable  conclusion  that  practically  all  the  operations 
actually  performed  for  the  removal  of  this  disease  are  to 
be  condemned.  Observe  that  I  speak  not  of  the  opera- 
tions which  might  be  performed,  but  those  which  in  gen- 
eral are  performed.  It  is  not  necessary  to  describe  the 
average  operation  as  "criminal,"  as  advanced  surgeons 
do:  but  their  verdict  may  be  noted. 

No  such  condemnation  applies  to  the  various  pallia- 
tive operations  which  do  not  touch  the  tumor  at  all,  and 
which  therefore  do  not  stimulate  its  growth  and  increase 
its  malignancy.  Such  are  the  operations  for  making  arti- 
ficial openings  in  the  intestine  or  the  stomach,  or  for 
establishing  short  routes  between  various  parts  of  the 
alimentary  canal  in  order  to  avoid  an  obstruction.  For 
some  time  to  come  such  cases  as  these,  plainly  capable 
of  being  relieved  without  considerable  risk  by  the  sur- 
geon, will  continue  to  occur. 

The  general  answer  to  this  argument  will  be,  how- 
ever, that  though  imperfect  operations  may  tend  to 
shorten  life  indirectly  by  increasing  the  malignancy  of 
the  cancerous  tissue  which  is  left  behind,  yet  the  removal 
of  a  primary  tumor  of  the  breast  or  tongue  may  at  any 
rate  relieve  the  patient  from  much  pain,  from  mechanical 
inconvenience,  and  also  from  the  chronic  blood-poison- 
ing, not  to  mention  the  unbearable  odor  due  to  the  growth 
of  microbes  in  the  tumor.  To  this  reasonable  argument 
I  reply  that  trypsin  and  amylopsin  can  effect  all  these 
ends,  not  to  mention  far  more.  I  have  repeatedly  seen 
trypsin  abolish  the   pain   of  cancer   altogether   in   cases 


lU  THE  CONQUEST  OF  CANCER 

where  morphine  in  large  doses  had  failed,  as  it  often 
does  fail.  Furthermore,  the  local  application  of  these 
ferments  dissolves  away  like  magic  the  whole  of  the  dead 
tissue  which  accumulates  on  the  surface  of  an  exposed 
growth.  I  say  "like  magic,"  and  the  results  are  only 
adequately  so  described;  but  of  course  there  is  nothing 
remarkable  in  the  digestion  of  dead  tissue  by  these  two 
intensely  powerful  ferments ;  and  the  real  wonder  is  that 
they  have  not  regularly  been  used  for  decades  past  in  order 
painlessly  and  certainly  and  completely  to  dispose  of  all 
the  necrotic  and  decomposing  and  horribly  putrid  tissue 
which  is  so  constant  a  feature  of  all  exposed  cancers — 
that  is  to  say,  of  the  very  great  majority  of  cancers  at 
some  period  or  other.  This  book  will  be  read  by  many 
skeptics.  To  them  I  appeal  on  this  point :  whatever  else 
they  disbelieve,  they  know  as  well  as  I  do — many  of 
them  knew  it  before  I  was  born — that  trypsin  digests 
lifeless  proteid  matter.  This  involves  no  theory  of  can- 
cer, and  has,  as  such,  nothing  to  do  with  cancer.  They 
know,  also,  that  the  exposed  surface  of  a  cancer  in- 
variably dies  sooner  or  later,  and  that  the  dead  tissue 
undergoes  bacterial  decomposition,  involving  the  pro- 
duction of  blood-poisoning  and  unspeakable  fcetor.  The 
so-called  "cachexia"  of  cancer,  the  loss  of  weight,  the 
yellow  skin  and  so  forth,  are  now  known  to  be  largely, 
if  not  entirely,  due  to  this  accident,  as  it  may  be  called, 
though  it  is  an  accident  all  but  invariable.  Will  you 
not,  then,  consent  simply  to  try  the  local  application  of 
trypsin  as  a  digestive  of  dead  tissue  in  these  cases?  In 
point  of  fact,  the  constant  and  immediate  result — mani- 
fest in  some  degree  within  twenty-four  hours — is  the  ab- 
solute disappearance  of  all  the  dead  tissue,  and  the  com- 
plete suppression  of  the  foetor.     If  trypsin  did  nothing 


CANCER  AND  SURGERY  125 

else,  its  introduction  would  be  the  greatest  boon  that  has 
come  the  way  of  the  cancer-patient  since  the  introduction 
of  the  hypodermic  use  of  morphine  and  antiseptic  sur- 
gery. 

As  for  surgical  operation  to  relieve  pain,  I  have  never 
yet  heard  a  patient  complain  of  cancerous  pain  while 
undergoing  trypsin  injections  under  my  direction.  Noth- 
ing could  be  more  remarkable  or  beneficent ;  but  since  I 
know  that  any  treatment  will  cure  any  pain  if  only  the 
patient  believes  that  it  will,  I  have  never  laid  upon  this 
fact  the  stress  that  it  deserves. 

Surgical  operation,  in  order  to  remove  a  f ungating 
and  poison-producing  mass,  should  now  be  no  longer 
necessary.  These  features  of  cancer,  including  its  odor, 
are  no  more  known  to  those  who  employ  the  new  treat- 
ment properly  than  are  the  pain  and  foetor  and  foulness 
of  surgery  fifty  years  ago  to  the  modern  surgeons :  com- 
petence in  each  case  being  assumed. 

As  strictly  relevant  to  this  question  of  palliative  opera- 
tion, I  may  here  notice  a  case  carefully  watched  by  myself 
in  conjunction  with  the  responsible  physician,  to  whom 
I  referred  the  patient  on  her  application  after  reading 
my  articles  in  the  Daily  Mail.  The  case  is  recorded  else- 
where by  the  physician  in  charge  of  it  {General  Prac- 
titioner, August  31,  1907.) 

The  patient,  a  woman,  had  had  a  cancer  of  the  breast 
removed  by  a  prominent  surgeon  at  the  Middlesex  Hos- 
pital. The  said  surgeon  need  not  be  further  particu- 
larized than  by  saying  that  his  name  was  published  as 
concurring  in  the  adverse  opinions  on  trypsin  which  came 
from  that  hospital  in  the  summer  of  1907,  and  as  having 
been  responsible  for  the  patients  on  whom  trypsin  was 
tried. 


126    ^       THE  CONQUEST  OF  CANCER 

The  growth  recurred,  and  the  patient  regularly  visite'd 
the  Middlesex  Hospital  and  was  seen  by  the  surgeon 
who  performed  the  operation.  She  had  a  large  ulcer 
in  the  site  formerly  occupied  by  the  breast,  and  this, 
when  she  came  under  the  pancreatic  treatment,  was  cov- 
ered with  a  dark  and  foetid  necrotic  mass.  The  supra- 
clavicular glands  were  involved,  and  there  were  several 
small  growths  in  the  skin.  Had  the  patient  belonged  to 
another  class  of  society,  a  second  operation  would  prob- 
ably have  been  performed  in  this  case.  As  it  was,  the 
only  treatment  employed  was  the  presentation  of  carbolic 
acid  to  the  patient,  with  instructions  to  use  it.  I  may 
remark  in  passing  that  few  things  in  this  whole  business 
have  appeared  more  lamentable  to  me  than  the  fashion  in 
which  surgeons  are  wont  to  deal  with  cases  that  are  past 
help  from  the  knife.  This  patient  suffered  much  pain: 
she  was  a  typical  example  of  cancer  cachexia,  and  the 
odor  of  the  growth — or  rather  of  the  dead  tissue  upon  it*' 
— was  indescribable,  and  made  her  unendurable  by  her- 
self or  her  friends.  A  palliative  operation  would  have 
temporarily  relieved  her,  though  doubtless  stimulating 
the  growth.  The  application  of  carbolic  acid  to  the  out- 
side of  the  necrotic  mass  did  practically  nothing,  though 
in  so  far  as  it  reached  the  living  growth  it  would  stimu- 
late it  according  to  Von  Leyden's  law. 

Trypsin  transformed  that  patient  at  once.  The  whole 
of  the  dead  tissue  was  promptly  digested  away — as  all 
dead  tissue  may  always  be  digested  away  by  trypsin, 
though  even  this  necessary  fact  was  not  reported  from 
the  Middlesex  Hospital — the  horrible  fcetor  vanished  ab- 

*The  odor  of  cancer  is  always  due  to  this  cause,  which  trypsin, 
of  course,  can  readily  remove.  It  might  have  been  employed  for 
this  purpose  ever  since  its  discovery,  now  nearly  fifty  years  ago. 


CANCER  AND  SURGERY  127 

solutely,  and  the  patient's  general  condition  was  altered 
beyond  recognition. 

The  treatment  did  for  her,  without  pain  or  risk,  every- 
thing that  a  palliative  operation  could  possibly  have  done, 
and  did  so  without  stimulating  the  living  tumor.  Many 
observers  have  recorded  similar  facts ;  and  to  the  surgeon 
or  other  critic  who  is  prepared  to  deny  all  else,  I  would 
say,  "Do  you  deny  that  an  active  proteolytic  ferment  can 
and  must  digest  dead  proteid  tissue?  If  it  can,  as  you 
know  it  can,  will  you  not  use  it  for  this  purpose  in  your 
advanced  cancer  cases?" 

For  the  purposes  of  the  argument  it  has  been  assumed 
by  almost  all  the  critics  of  my  articles  in  Great  Britain 
and  the  United  States  since  March,  1906,  that  all  patients 
suffering  from  cancer  can  be  cured,  or  can  at  least  have 
their  lives  prolonged  by  surgery :  words  like  "criminal" 
and  "brutal"  and  "irresponsible"  have  been  freely  ad- 
dressed to  me  on  the  assumption  that,  in  so  far  as  my 
campaign  succeeded,  it  would  effect  the  death  of  patients 
whom  surgery  would  otherwise  have  saved.  Among  the 
facts  ignored  have  been  the  indisputable  and  everywhere 
admitted  fact  that  the  vast  majority — certainly  more  than 
99.9  per  cent. — of  cases  are  not  saved  by  the  surgery 
that  is,  however  many  might  be  saved  by  the  surgery 
that  might  be.  Worse  than  this,  my  critics  have  totally 
ignored  the  existence,  at  any  given  moment,  of  hundreds 
of  thousands  of  patients  throughout  the  world  who  are 
admittedly  "past  all  surgery."  In  Great  Britain  alone, 
despite  the  surgeons,  some  thirty  thousand  persons  die 
of  cancer  every  year,  and  the  number  of  cancer  patients 
at  any  given  moment  has  been  variously  estimated  as  at 
from  sixty  to  one  hundred  thousand.  Now  of  all  these 
certainly  the  great  majority  are  admittedly  past  all  sur- 


128     THE  CONQUEST  OF  CANCER 

gery.  Some  of  them  have  been  operated  upon  once  or 
oftener,  some  have  delayed  too  long  for  any  surgeon  to 
undertake  the  operation,  and  a  not  inconsiderable  pro- 
portion have  been  wholly  inoperable  from  the  first,  A 
large  proportion  have  been  incapable  of  cure  by  operation 
from  the  first.  Thus  for  tens  of  thousands  of  persons 
in  every  country  in  the  world  at  any  time  all  hope  from 
surgery  is  over,  and  the  number  whom  surgery  can  help 
at  all  is  relatively  very  small,  while  the  number  whom 
surgery  cures  is  all  but  negligible — it  being  remembered 
that  I  speak  of  actual  surgery,  and  not  of  what  might  be 
if  all  surgeons  were  like  the  best  and  all  patients  applied 
at  once. 

This  is  to  say  that  the  argument  from  surgery  is  totally 
irrelevant  to  all  but  a  minute  minority  of  cancer-patients 
at  any  given  time.  The  critics,  without  exception,  have 
assumed  not  merely  that  the  new  treatment  was  worth- 
less, but  that  the  advocacy  of  a  worthless  treatment  is 
equivalent  to  the  injury  of  all  cancer-patients.  As  a 
matter  of  fact,  the  most  blackguardly  and  unscrupulous 
quack  can  only  injure  very  few  patients  by  robbing  them 
of  the  hope  of  surgery,  actual  surgery  having  never  had 
any  hope  for  nearly  all,  and  offering  hope  at  a  given 
moment  to  only  a  tiny  proportion. 

The  actual  fact  is  that  the  great  majority  of  cancer- 
patients  are  without  hope  or  help  in  the  world  except 
from  measures  other  than  surgery.  It  is  commonly  sup- 
posed, as  it  was  by  myself  until  last  year,  that  cancer  is  a 
"surgical  disease."  But  analysis  of  the  facts  shows  that 
though  surgery  cures  absolutely  a  tiny  proportion  of 
cases — say  perhaps  as  many  as  o.oi  per  cent. — the  great 
majority  of  the  remainder  probably  have  their  lives  short- 
ened by  the  surgery  that  is  actually  practiced.     As  for 


CANCER  AND  SURGERY  129 

the  cases  that  are  curable  when  they  come  up  for  treat- 
ment and  would  receive  really  curative  treatment,  I  have 
yet  to  hear  of  a  single  one  anywhere  that  was  dissuaded 
from  operation  by  my  crusade  and  found  trypsin  and 
amylopsin  wanting.  I  propose  to  defend  myself  without 
reserve  or  qualification,  therefore,  against  the  charge  that 
I  have  injured  any  one  whatsoever  (except  the  surgeons) 
by  my  campaign,  even  though,  in  order  to  obtain  a  hear- 
ing for  trypsin  at  all,  I  necessarily  had  to  begin  it  when 
the  treatment  was  in  a  very  inchoate  stage,  and  active 
injections  were  very  difficult  to  obtain.  On  the  other 
hand,  I  could  print  many  grateful  letters  received  from 
patients  who  at  least  were  relieved  of  pain  and  foetor  and 
cachexia. 

The  fact  is,  notwithstanding  the  splendid  work  done 
by  a  very  few  surgeons,  that  for  the  overwhelming  ma- 
jority of  all  patients  in  the  present  state  of  public  infor- 
mation as  to  the  early  signs  of  cancer — the  consequences 
of  which  Mr.  Childe  has  so  terribly  demonstrated — and 
in  the  present  state  of  surgery  as  it  is  actually  practiced, 
there  is  no  help  in  the  world  but  morphine  and  the  fer- 
ments, and  no  hope  of  prolongation  of  life  or  of  cure 
except  in  the  ferments  alone.  Those  who  have  opposed 
this  treatment,  some  honestly  and  others  dishonestly,  have 
deprived  and  are  depriving  all  but  very  few  cancer- 
patients  of  their  sole  hope :  the  substitute  of  surgery  is 
of  dubious  value  even  where  it  can  be  employed,  and  is 
unemployable  in  the  great  majority  of  cases  at  any  given 
time.  In  the  absence  of  any  possibility  that  patients  will 
suddenly  take  to  coming  in  time,  and  that  surgery  in 
general  will  suddenly  reach  the  level  of  the  best  surgery, 
no  words  can  adequately  condemn  those  who  are  still 
prepared  to  deprive  these  patients  of  a  mode  of  treat- 


130     THE  CONQUEST  OF  CANCER 

ment  which  offers  hope,  reHeves  pain,  aboHshes  foetor 
and  destroys  all  necrotic  tissue  without  any  risk  or  serious 
expense,  even  assuming  that  it  can  do  no  more. 

In  summing  up,  we  may  say  that  in  the  rare  cases 
where  a  perfect  operation  might  and  would  be  performed 
— two  distinct  conditions — the  patient  should  be  operated 
upon.  The  operation  involves  some  immediate  risk  to 
life,  but  it  may  accomplish  at  once  what  no  other  means 
can  accomplish  except  in  months,  if  then — and  the  use 
of  the  ferments  is  not  excluded,  though  it  is  probably 
prejudiced,  as  I  show  elsewhere,  by  the  operation. 

But  in  that  vast  majority  of  cases  where  a  perfect  oper- 
ation either  cannot  be  performed  or  will  not  be  performed, 
it  is  seriously  to  be  questioned  whether  an  imperfect 
operation  should  be  performed  at  all.  It  involves  imme- 
diate risk  to  life,  it  accelerates  the  growth  of  the  malig- 
nant tissue  which  it  leaves  behind,  and  since  a  radical 
cure  is  in  any  case  out  of  the  question,  life  cannot  be 
sacrificed  by  at  least  postponing  the  operation  while  the 
pancreatic  ferments  are  given  a  trial.  They  will  at  least 
do  all  that  the  knife  could  do  in  such  cases,  not  to  say 
much  more;  and  it  is  much  better  to  employ  them  first, 
on  the  grounds  I  have  cited,  than  to  follow  the  procedure 
which,  I  do  not  doubt,  many  surgeons  will  still  insist 
upon  for  some  time  to  come,  even  in  cases  where  they 
know  that  they  cannot  and  will  not  effect  a  radical  cure. 
This  is  to  use  the  knife  until  it  can  be  used  no  longer; 
and  when  the  patient's  strength  is  exhausted,  when  the 
disease  has  assumed  a  more  malignant  type,  when  the 
knife  and  the  disease  between  them  have  destroyed  va- 
rious tissues  and  organs  more  or  less  necessary  to  life, 
the  ferments  will  be  employed.  If,  at  this  stage,  they  fail 
to  save  the  patient — not  having  the  power  to  re-create 


CANCER  AND  SURGERY  131 

new  organs  or  tissues  upon  the  ruins  of  the  old — the 
surgeon  will  triumphantly  point  to  the  fact  and  cite  the 
history  of  the  case  as  proving  that  "there  is  no  cure  for 
cancer  but  the  knife,"  though  the  knife  has  had  every 
chance  and  the  patient  lies  dead  before  him!  It  is  a 
brave  argument,  and  its  audacity  gives  it  success  at  this 
very  hour. 

At  the  meeting  of  the  British  Medical  Association  in 
Exeter,  1907,  there  was  a  discussion  on  uterine  cancer, 
which  has  much  significance  for  us.  Among  the  opin- 
ions quoted,  it  will  suffice  to  take  that  of  the  great  Italian 
gynaecologist,  Pozzi,  as  typical.  He  denies  that  definitive 
cure  of  uterine  cancer  has  yet  been  proved:  "Even  in 
the  most  favorable  cases  one  can  only  speak  of  prolonged 
survivals";  and  he  has  had  only  two  such  "prolonged 
survivals"  in  204  hospital  patients  operated  upon  for 
cancer.  Other  surgeons  have  obtained  much  more  favor- 
able results,  notably  by  means  of  the  operation  of  Wert- 
heim,  who,  however,  has  an  immediate  mortality  of  20 
per  cent. — that  is  to  say,  one  patient  in  five  is  killed  by 
the  operation,  while  one-tenth  (11  per  cent,  is  Wert- 
heim's  own  figure)  are  still  without  recurrence  after 
five  years :  in  other  words,  by  the  best  known  operation, 
one-fifth  are  killed  outright,  and  an  uncertain  proportion 
of  one-tenth  are  cured.  The  issue  of  the  discussion  was 
to  insist  upon  the  importance  of  early  detection  of  the 
disease,  and  it  was  resolved  that  a  committee  should  be 
appointed  "to  consider  the  best  means  of  disseminating 
knowledge  of  the  importance  of  the  early  recognition 
of  uterine  cancer."  But  the  fact  for  the  present  is  that, 
in  the  actual  state  of  things,  surgery  is  all  but  out  of 
court  as  affording  a  cure  for  uterine  cancer;  and,  short 


13^  THE  CONQUEST  OF  CANCER 

of  cure,  the  probability  would  seem  to  be  that  its  influence 
on  the  disease,  as  we  have  seen,  is  that  of  a  stimulant. 

At  the  same  meeting  of  the  B.  M.  A.,  Mr.  Butlin,  an 
unsurpassed  authority,  delivered  the  "Address  in  Sur- 
gery," which  was  devoted  to  the  question  of  the  contagion 
of  cancer;  and  therein  he  insisted  upon  the  risk,  during 
operation,  of  infecting  the  wound  with  living  cells.  He 
says :  "Cancers  should  not  be  cut  into  unless  for  diag- 
nosis, and  the  wound  should  be  tightly  closed  before  the 
actual  operation  is  commenced.  The  instruments  which 
were  used  for  the  purpose  of  diagnosis  must  not  be  used 
again  until  they  have  been  boiled.  Exposed  or  ulcerated 
cancers  should  not  be  pressed  against  or  dragged  across 
raw  surfaces  made  in  the  course  of  the  operation.  And 
care  should  be  taken  that  breaking-down  cancers  are  not 
opened  during  operation.  If  they  are  opened  by  mis- 
chance, means  should  be  taken  to  cleanse  the  surface  of 
the  wound  and  to  destroy  the  exuded  contents  of  the 
cancer-cavity." 

No  one  will  question  for  a  moment  that,  in  general, 
these  conditions  are  not  complied  with,  and  in  the  light 
of  Mr.  Butlin's  researches  there  can  be  no  doubt  as  to 
the  result.  This  evidence  tends,  with  all  the  evidence 
that  has  already  been  detailed,  to  the  serious  conclusion 
that  the  performance  of  surgical  operation  in  cancer, 
apart  from  palliative  operations  which  do  not  touch  the 
growth  at  all,  should  be  confined  exclusively  to  those 
extremely  early  cases  which,  unfortunately,  the  surgeon 
so  seldom  sees.  The  necessary  and  warrantable  demand 
of  the  surgeons  for  early  cases  is  based  on  their  demon- 
stration of  the  deplorable  results  they  obtain  in  cases  that 
are  not  early,  despite  the  extension  of  their  operations  to 
a  degree  which  involves  a  much  larger  primary  mortality 


CANCER  AND  SURGERY  133 

than  the  percentage  of  patients  cured;  the  chances  being 
often  definitely  higher  that  the  operation  will  kill  outright 
than  that  it  will  cure.  Wertheim's  operation,  for  in- 
stance, so  highly  praised,  kills  one  in  five  at  once,  and 
cures  less  than  one-tenth.  This  simply  means,  though 
the  necessary  inference  is  not  drawn,  that  the  overwhelm- 
ing majority  of  the  operations  actually  performed  for 
cancer  at  the  present  day  should  not  be  performed.  They 
are  statistically  shown  to  take  much  more  life  than  they 
save.  It  is  beyond  comprehension  that  such  results  as 
Wertheim's,  specially  put  forward  as  constituting  a 
triumph  for  surgery — results  which  plainly  assert,  though 
apparently  not  plainly  enough,  that  they  take  more  lives 
than  they  save — should  be  quoted  except  in  order  to 
assert  the  only  warrantable  conclusion — that  they  should 
not  be  performed.  If  the  best  results  take  two  lives  in 
order  to  save  one  (Wertheim  has  a  primary  mortality  of 
20  per  cent,  and  11  per  cent,  of  "survivals"  for  five 
years),  we  may  estimate  the  value  of  the  results  obtained 
by  the  surgery  of  cancer  in  general. 

I  am  at  a  loss  to  conceive  how  any  one,  surgeon  or 
layman,  can  look  at  such  figures  as  these  without  admit- 
ting that,  if  any  conclusion  at  all  is  to  be  drawn  from 
them,  it  is  that,  of  all  operations  for  cancer  at  present 
performed,  only  a  minute  proportion  are  legitimate.  The 
most  radical  and  recent  operations  for  uterine  cancer,  for 
instance,  are  self-confessed  to  be  a  gamble  for  life  or  im- 
mediate death,  with  the  chances  very  heavily  in  favor 
of  the  latter;  and  the  considerations  advanced  by  Von 
Leyden  and  Sir  James  Paget  and  many  others  suggest 
that  death  is  hastened  by  the  operation  in  the  case — to 
take  a  current  instance — of  the  seven-tenths  of  patients 
who  remain,  when  two-tenths  are  accounted  for  as  killed 


lS4i  THE  CONQUEST  OF  CANCER 

outright,  and  one-tenth  as  free  from  recurrence  after  five 
years.  And  we  are  deaHng,  be  it  remembered,  with  the 
rare  surgeons  here  and  there,  who  can  operate  on  only 
a  tiny  proportion  of  all  cancer-patients,  and  who  choose 
their  cases. 

Until,  then,  the  actual  facts  as  to  the  quality  of  the 
operations  performed,  and  their  date  relatively  to  the 
onset  of  the  disease,  are  utterly  revolutionized,  we  cannot 
avoid  the  conclusion  that  very  nearly  the  whole  of  the 
surgical  treatment  of  cancer,  as  it  is  actually  practiced 
to-day,  is  illegitimate  and  should  be  suspended. 

In  its  place  there  is  here  put  forward  a  mode  of  treat- 
ment by  various  cancrotoxic  ferments,  which,  in  its  vari- 
ous forms,  has  already  achieved  many  carefully  recorded 
successes  even  where  surgery  has  failed,  can  and  does 
habitually  accomplish,  when  properly  practiced,  immense 
palliation  of  the  disease  in  all  its  most  distressing  aspects, 
and  has  no  primary  mortality  whatever. 

The  present  volume  is  written  on  my  own  responsi- 
bility, notwithstanding  the  indispensable  help  I  have  in- 
cidentally received  from  Dr.  Beard.  He  is  not  to  be 
credited  or  discredited  with  anything  in  it  that  is  not 
directly  attributed  to  him.  It  is  necessary  to  say  that 
the  views  expressed  in  the  present  chapter  by  no  means 
entirely  meet  with  his  approval.  He  insists  that,  since 
nature  does  not  operate  upon  trophoblast,  and  permits 
it  to  grow  for  only  seven  weeks  at  most  before  she  begins 
to  attack  it — in  the  case  of  man — our  business  should  be 
to  reproduce  nature's  method  as  closely  as  possible.  In 
the  light  of  A^on  Leyden's  work  he  is  more  strongly  con- 
vinced than  ever  that  surgical  operation,  in  general, 
affects  a  tumor  in  such  a  way  as  gravely  to  complicate, 


CANCER  AND  SURGERY  135 

if  not  to  make  impossible,  the  reproduction  of  nature's 
method  in  deahng  with  trophoblastic  tissue.  He  main- 
tains that  it  is  impossible  to  do  more  than  demonstrate 
nature's  method,  and  that  if  this  for  success  requires 
certain  conditions,  it  is  not  the  fault  of  the  therapeutic 
method,  which  he  advocates  on  the  model  of  the  natural 
method,  that  it  demands  similar  conditions  for  success. 
Thus,  apart  from  purely  palliative  operations,  such  as 
the  making  of  artificial  openings  in  the  bowel  at  a  dis- 
tance from  the  disease.  Dr.  Beard  would  limit  the  func- 
tion of  surgery  entirely  to  the  removal  of  the  remains 
of  dead  tumors  killed  by  trypsin,  the  irritation  of  a  living 
tumor  by  the  knife  being  regarded  by  him  as  an  artificial 
disturbance  which  renders  invalid  the  attempt  to  repro- 
duce nature's  method  of  dealing  with  malignant  tissue, 
which  normal  trophoblast  unquestionably  is.  He  be- 
lieves, and  the  opinion  is  shared  by  Dr.  Cleaves,  whose 
experience  is  large,  that  recurrent  cases — i.e.  cases 
already  modified  by  the  knife — are  not  really  suitable  for 
the  new  treatment.  Not  a  few  of  such  cases  have  been 
reported  cured  by  it,  and  many  more  vastly  relieved  and 
their  fatal  advance  arrested  or  retarded;  but  Dr.  Beard 
will  not  lay  much  stress  upon  them. 

At  present,  however,  the  treatment  has  been  practically 
confined — and  necessarily  so — to  advanced  and  recurrent 
cases,  often  many  times  recurrent.  I  personally  cannot 
take  upon  myself  the  responsibility  of  counselling  the 
refusal  of  operation  in  such  rare  and  early  cases,  uncom- 
plicated by  secondary  growths  (though  no  one  can  ever 
be  sure  of  this),  as  do  occasionally  come  before  the 
surgeon.  I  believe  that  I  have  shown  good  reason,  de- 
rived largely  from  the  mouths  of  surgeons  themselves, 
why  operations  upon  the  disease  in  all  other  cases — i.e. 


1S6  THE  CONQUEST  OF  CANCER 

certainly  not  less  than  99.9  per  cent,  of  all  operations — 
are  to  be  condemned  and  should  be  abandoned.  There 
remain,  as  offering  a  difference  of  opinion  between  Dr. 
Beard  and  myself,  only  the  very  rare  cases  in  which  the 
surgeon  honestly  and  unreservedly  believes  that  an  opera- 
tion can  (not  might)  be  performed — and  more,  that  he 
will  actually  perform  this  operation  on  this  occasion — 
which  will  radically  extirpate  every  portion  of  malignant 
tissue  in  the  patient's  body. 

I  do  not  regard  this  question  as  a  serious  one,  for 
there  are  not  a  few  early  cases,  if  the  whole  of  civilization 
and  the  lower  animals  be  included,  in  which  the  patient 
for  some  reason  or  another  declines  to  be  operated  upon, 
or,  as  in  animals,  may  be  legitimately  experimented  upon. 
Xo  such  early  and  favorable  case,  so  far  as  I  know,  has 
yet  come  under  the  competent,  or  even  the  incompetent, 
performance  of  the  pancreatic  method  of  treatment.  It 
has  had  to  establish  its  claim  to  a  hearing  by  means  of 
cases  abandoned  by  the  surgeons  after  one  or  many  oper- 
ations; but  early  and  primary  cases,  where  the  patient 
refuses  operation,  or  is  an  animal,  will  doubtless  shortly 
come  under  the  treatment,  and  the  results  should  speedily 
and  finally  settle  the  question. 


CHAPTER  XII 

THE  PREPARATION   OF  THE  FERMENTS 

We  must  now  consider  a  practical  matter  of  great 
complexity  which  may  seem,  and  did  at  first  seem,  to  be 
very  simple.  This  is  the  preparation  of  pancreatic  fer- 
ments for  purposes  of  injection.  They  are  contained — 
or  at  any  rate  their  immediate  antecedents  are  contained 
— in  any  conveniently  obtained  pancreas,  such  as  that 
of  a  pig  or  an  ox  or  sheep.  From  the  pancreas  of  such 
a  recently  killed  animal  actively  digestive  solutions  may 
be  prepared  by  means  of  glycerine.  It  might  be  thought, 
then,  that  no  more  was  necessary  than  to  make  such 
solutions,  sterilize  them,  and  seal  them  up;  nor  was  any 
great  difficulty  offered  by  the  fact  that  sterilization  by 
heat  was  inadmissible,  since  this  destroys  the  digestive 
power  of  trypsin.  There  is  no  difficulty  in  obtaining 
material,  nor  in  making  clear  solutions  and  sealing  them 
up  in  neat  little  glass  phials.  Unfortunately,  however, 
more  than  this  was  necessary.  Powerful  though  these 
ferments  be,  they  are  also  delicate.  One  of  the  chemists 
who  have  worked  at  this  subject  has  compared  trypsin  to 
dynamite,  with  the  comment  that  the  comparison  really' 
does  poor  justice  to  trypsin.  Indeed,  the  digestive  power 
of  this  substance,  involving  no  loss  of  its  own  power, 
has  long  been  one  of  the  standing  wonders  of  chemistry ; 
but  yet  it  demands  a  nicety  of  conditions  in  which  to 
work  or  even  to  retain  its  possibility  of  action.     These 

137 


138     THE  CONQUEST  OF  CANCER 

facts  were  not  fully  realized  at  first,  and  even  when  the 
difficulties  were  realized  by  some  workers,  they  were 
too  commonly  thought  to  have  been  overcome  when  they 
really  were  not.  Let  us  now  look  at  the  facts  which 
rendered  necessary  a  much  closer  study  than  had  hitherto 
been  made  of  the  conditions  under  which  these  ferments 
may  be  prepared  for  use. 

In  critically  comparing  all  the  results  that  have  hitherto 
been  obtained,  we  have  found  ourselves  compelled  to 
observe  certain  anomalies,  the  explanation  of  which  was 
not  forthcoming.  It  might  quite  well  be  expected  that 
certain  kinds  of  cancer,  those  for  instance  which  are 
known  to  grow  more  slowly,  would  yield  more  quickly 
than  others  to  treatment  by  the  pancreatic  ferments ;  but 
no  such  general  result  was  to  be  observed.  The  response 
to  the  treatment  bore  no  definite  and  absolute  cor- 
respondence to  the  type  or  the  previous  history  of  the 
growth.  Indeed,  it  was  found  that  when  the  treatment, 
apparently  constant,  was  applied  in  various  cases  which, 
so  far  as  could  be  observed,  seemed  to  be  precisely  sim- 
ilar, the  results  obtained  were  quite  discrepant:  whilst 
in  one  case  the  tumor  responded  at  once  and  most  satis- 
factorily, in  another  the  injections  might  have  consisted 
of  salt  solution  and  nothing  more  so  far  as  any  observable 
results  were  concerned.  All  the  chief  kinds  of  tumors 
have,  at  one  time  or  another,  shown  response  to  the 
treatment — a  point  which  is  evidently  of  the  greatest 
importance.  But  they  have  by  no  means  always  shown 
the  same  response,  or,  indeed,  any  response  at  all.  Fur- 
thermore, while  one  observer  has  obtained  results  within  a 
few  weeks,  another  observer,  working  upon  cases  appar- 
ently identical,  and  giving  doses  that  purported  to  be  the 
same,  has  had  to  wait  many  months. 


PREPARATION  OF  THE  FERMENTS    139 

There  were  and  are,  of  course,  certain  details,  already 
noted,  which  would  go  a  long  way  to  explain  these 
anomalies.  There  were,  first  of  all,  the  practitioners  who 
did  their  work  in  what,  not  to  put  too  fine  a  point  on  it, 
must  be  called  a  dirty  fashion :  whether  by  ill-luck,  such 
as  may  sometimes  attend  any  one,  or  by  carelessness,  their 
injections  were  followed  by  local  symptoms  which  would 
suggest  that  Pasteur  and  Lister  had  never  been  born. 
Notwithstanding  the  experience  of  the  Middlesex  Hos- 
pital, nothing  more  need  here  be  said  as  to  the  production 
of  abscesses  by  the  injections,  for  the  experiences  already 
published  abundantly  prove  that  these  should  and  need 
never  occur. 

Then,  again,  there  were  the  practitioners  who,  quite 
excusably  ignorant  of  the  delicate  nature  of  the  ferments, 
neglected  to  cool  the  hypodermic  needle  after  boiling  it, 
or  failed  to  wait  for  the  cooling  of  the  water  with  which 
the  injections  are  diluted,  and  which,  of  course,  must 
first  be  boiled  so  as  to  render  it  sterile.  If  the  ferments 
be  heated  above  only  60-65°  C.,  they  are  rendered  abso- 
lutely inert. 

Nevertheless,  when  all  these  sources  of  failure  were 
excluded,  the  anomalies  to  which  I  have  referred  still 
remained.  It  became  necessary,  therefore,  to  begin  at 
the  very  beginning,  and  to  discover  the  facts  of  ferment 
solutions  in  general. 

These  facts  have  been  startling  enough.  The  various 
firms  of  chemists  who  now  supply  these  ferments  in  the 
form  of  injections  for  the  treatment  of  cancer  are  quite 
above  suspicion  as  to  their  probity.  They  doubtless  all 
use  the  best  methods  known  to  them,  and  use  them  with 
the  most  scrupulous  care.  Nevertheless  the  results  which 
they  obtain  are  in  some  cases  singularly  unfortunate,  as 


140     THE  CONQUEST  OF  CANCER 

we  shall  see.  Furthermore,  let  us  note  that  if  such  re- 
sults have  been  obtained  by  all  but  one  of  the  best 
firms,  we  need  not  look  far  ahead  in  order  to  prophesy- 
that  very  soon,  when  firms  all  and  sundry  enter  into 
competition  in  this  matter,  the  market  will  be  flooded 
with  preparations  that  are  simply  worthless.  Quite  suffi- 
cient harm  has  already  been  wrought  in  this  way.  In 
the  first  place,  many  patients  have  failed  to  find  relief 
because,  as  we  shall  see,  they  were  undergoing  the  pan- 
creatic treatment  only  in  name.  More  serious  still,  be- 
cause of  its  wider  results,  is  the  fact  that  these  failures 
and  abortive  experiments  are  in  some  cases  recorded, 
with  the  result  of  gravely  discrediting  the  treatment  and 
delaying  its  general  acceptance.  It  is  absolutely  neces- 
sary, as  we  shall  see,  that  we  should  demand  a  quite  new 
series  of  requirements  before  undertaking  the  prosecution 
of  this  work. 

Lately  there  have  been  conducted,  first  in  New  York, 
and  later  also  in  London  and  Berlin,  a  large  number 
of  chemical  experiments  with  the  pancreas  gland,  as 
to  the  mode  by  which  its  ferments  may  be  best  ex- 
tracted from  it.  At  the  same  time  there  have  been  in 
process  a  large  number  of  observations  upon  the  actual 
digestive  activity  of  the  various  preparations  that  are 
already  upon  the  market.  Lastly,  a  great  deal  of  work 
has  been  done  in  the  attempt  to  ascertain  how  long  these 
various  preparations  will  retain  their  activity,  assuming 
that  they  possessed  any  to  begin  with. 

In  the  first  place,  then,  we  have  found  that  various 
preparations  stated — quite  honestly,  of  course — ^to  con- 
tain such  and  such  a  percentage  of  trypsin  or  amylopsin, 
or  both,  may  differ  in  their  activity  in  ratios  actually  so 
high  as  that  of  i  to  500.     This  is  to  say,  that  two  injec- 


PREPARATION  OF  THE  FERMENTS    141 

tions  supposed  to  be  identical  may  actually  differ  so 
much  that  five  hundred  drops  of  the  one  will  be  required 
to  digest  the  same  amount  of  milk  as  will  be  digested 
by  one  drop  of  the  other.  Now  this  is  a  very  easy  fact 
to  state,  but  let  any  reader  consider  for  himself  what  it 
signifies  in  practice.  It  means  that  if  the  dose  of  the 
more  active  preparation  be  adequate,  that  of  the  other 
is  only  one-five-hundredth  part  of  what  it  ought  to  be. 
This  is  as  good  as  to  say  that  the  use  of  the  second  prep- 
aration is  an  expensive,  painful  and  fatal  farce.  Fer- 
ment injections,  of  which  no  more  ma)''  be  said,  are  being 
employed  at  this  moment,  I  cannot  doubt,  here  and  there, 
in  all  parts  of  the  world,  and  especially  in  Great  Britain. 

It  is  not  quite  clear  how  it  is  that,  in  the  course  of 
making  their  preparations,  certain  manufacturers,  even 
though  they  use  fresh  pancreas-gland  and  extract  the 
ferments  from  it  with  glycerine  in  a  perfectly  correct 
fashion,  manage  somehow  to  reduce  their  work  to  worth- 
lessness  by  the  time  the  injections  are  sealed  up  in  the 
little  glass  phials  in  which  they  are  dispensed.  There 
the  fact  remains,  however.  The  same  remark  applies 
to  preparations  made  from  tr3^psin  in  powder.  Some  of 
these  will  be  found  to  be  highly  active ;  others,  even  in 
concentration,  will  effect  no  change  in  dead  milk  in  an 
hour.  Evidently  it  is  a  sorry  business  attempting  to  cure 
cancer  with  such.  I  strongly  believe  that  no  injection 
made  up  from  trypsin  in  powder  is  desirable. 

We  must  find  in  the  first  place,  then,  some  accurate 
and  certain  means — simple  if  possible,  but  at  any  rate 
accurate — of  determining  the  activity  of  any  given  injec- 
tion. This  has  now  been  done.  I  am  anticipating  the 
publication  of  this  work  in  the  scientific  journals,  but  I 
have  been  doing  so  all  along  with  the  full  consent  of  the 


142     THE  CONQUEST  OF  CANCER 

original  workers  and  for  the  best  and  most  obvious  of  all 
possible  reasons. 

Amongst  the  papers  presented  to  the  Royal  Society  by 
the  late  Sir  William  Roberts,  of  Manchester,  who,  until 
his  death  a  few  years  ago,  was  the  greatest  living  au- 
thority on  digestion,  was  one  in  which  he  showed  that 
of  the  various  means  which  may  be  employed  for  esti- 
mating the  activity  of  the  digestive  ferments,  the  best  is 
what  he  called  the  meta-casein  test.  At  the  time  when 
his  work  was  done,  not  even  the  wisest  could  guess  the 
importance  which  it  would  afterwards  assume ;  but  there 
is  no  sterile  knowledge  in  the  whole  realm  of  things,  and 
this  is  now  bearing  fruit.  The  test  in  question  depends 
upon  certain  observable  changes  wrought  by  the  digest- 
ive ferments  in  the  chief  proteid  of  milk,  which  is  known 
as  casein. 

For  purposes  of  accuracy  it  is  necessary,  in  the  first 
place,  to  obtain  a  standard  milk,  and  that  which  has  been 
employed  is  what  we  may  call  London  County  Council 
milk,  which  contains  the  4  per  cent,  of  proteid  demanded 
by  that  body.  To  a  fixed  quantity  of  this  milk,  under 
fixed  conditions  of  temperature,  there  is  added  a  fixed 
quantity  of  the  ferment  preparation  that  is  to  be  tested, 
and  the  time  it  takes  to  change  the  milk  completely  is 
then  precisely  noted  in  minutes  and  seconds.  Whereas 
one  preparation,  diluted  ten  times,  will  produce  the  meta- 
casein  reaction  in  perhaps  forty-five  seconds,  another, 
undiluted,  will  effect  nothing  that  can  be  observed  in  an 
hour. 

Sir  William  Roberts,  as  was  his  fashion,  went  thor- 
oughly into  this  matter.  He  provided  a  convenient  for- 
mula whereby  the  result  of  such  experiments  can  be  ex- 
pressed in  units  of  digestive  activity.     The  mode  of  con- 


PREPARATION  OF  THE  FERMENTS    14S 

struction  of  the  formula  is  immaterial  here.  It  is  com- 
parable to  the  formula  employed,  as  many  readers  will 
know,  for  estimating  the  activity  of  the  diphtheria  anti- 
toxin. In  that  case  it  was  soon  found  impossible  to  make 
any  progress  so  long  as  the  strength  of  injections  was 
expressed  in  terms  of  what  was  put  into  them.  In  a  case 
like  this  we  must  express  the  strength  of  an  injection 
not  by  what  we  put  into  it  but  by  what  it  does.  The 
business  of  the  diphtheria  antitoxin  is  to  neutralize  the 
toxin  or  poison  of  diphtheria,  and  so  the  dose  is  now  ex- 
pressed in  units  of  neutralizing  power.  Similarly,  the 
business  of  the  digestive  ferments  trypsin  and  amylopsin 
is  to  digest,  and  therefore  the  proper  mode  of  expressing 
the  quantities  employed  would  evidently  be  in  units  of 
digestive  capacity.  This  digestive  capacity  is  "D"  in  the 
formula  of  Sir  William  Roberts,  and  this  mode  of  numer- 
ation is  as  superior  to  that  as  present  employed  as  science 
to  vague  opinion.  Observe  a  proof  of  this  superiority. 
Two  injections,  both  honestly  prepared,  may  purport  to 
be  identical.  Subject  them  to  this  new  mode  of  descrip- 
tion, and  whereas  the  value  of  one  is  found  to  be  500, 
the  value  of  the  other  is  found  to  be  0.7 — these  figures 
referring  to  digestive  capacity,  which  is,  of  course,  the 
vital  matter,  and  the  only  vital  matter,  in  this  connection, 
apart  from  the  possible  existence  of  poisonous  peptones  in 
the  injections. 

Very  plainly,  then,  we  must  make  a  new  demand  of 
the  chemists,  and  this  is  simply  that,  just  as  they  have 
standardized  their  preparations  of  other  drugs,  so  they 
must  standardize  their  preparations  of  these  ferments. 
When  a  doctor  pescribes  five  drops  of  tincture  of  nux 
vomica,  he  knows  that  this  will  always  contain  a  certain 
definite  quantity  of  strychnine,   and  so  in  other   cases; 


144)  THE  CONQUEST  OP  CANCER 

but  I  know  of  no  other  case  in  which  the  importance  of 
this  principle  of  standardization  can  be  compared  with 
that  of  the  case  we  are  now  considering.  The  chemist 
must  standardize  his  ferments,  and  when  that  is  done, 
the  public  and  the  profession  must  absolutely  ignore  all 
preparations  which,  while  professing  to  contain  this  and 
that  proportion  of  the  ferments,  are  not  standardized. 
The  stated  proportions  of  the  ferments  may  very  well 
have  been  put  into  the  preparations,  but  if  they  are  now 
incapable  of  digesting  milk  in  months,  it  is  not  well  to 
expect  them  to  cure  cancer. 

When  this  most  necessary  advance  has  been  achieved, 
we  can  begin  to  attach  some  significance  to  the  reports 
of  those  workers  who  fail  to  obtain  the  results  they  de- 
sire. Furthermore,  we  shall  then  be  able  to  attack  the 
question  of  dosage,  which  has  hitherto  been  in  a  state 
of  chaos.  Obviously  we  cannot  come  to  any  agreement 
if  we  imagine  that  20  drops  of  a  5  per  cent,  solution. of 
trypsin  always  means  one  and  the  same  thing,  whereas 
20  drops  in  one  case  may  really  be  equal  to  10,000  in 
another. 

Here  I  may  quote  certain  of  the  results  obtained  from 
examination  at  various  dates  of  four  sets  of  prepara- 
tions put  upon  the  market  by  the  four  firms  which,  in 
April,  1907,  alone  supplied  them.  As  the  table  shows, 
the  preparations  were  examined  at  three  different  dates, 
and  it  will  be  seen  that  in  nearly  every  case  experience 
wrought  considerable  improvement  in  them — that  is  to 
say,  preparations  issued  at  later  dates  were  more  effect- 
ive. I  only  wish  I  could  give  the  names  of  the  firms, 
but  that  is  not  really  necessary,  since  it  is  now  to  be 
expected  that  no  practitioner  will  employ  anything  but 
definitely    standardized    preparations.     The    figures    are 


PREPARATION  OF  THE  FERMENTS    145 

units  of  digestive  power.  The  letter  T  refers  to  units 
of  tryptic  power,  and  the  letter  A  to  units  of  amylolytic 
power.  As  regards  the  former,  two  methods  of  esti- 
mation were  employed,  and  their  discrepancy  in  certain 
cases  shows  how  difficult  and  complex  this  question  is — 
even  the  metacasein  test  being  doubtful. 

TABLE 

April,  1906.        February,  1907.  April,  1907. 

1.  T  =-  —  T  =  9.6  T  =  20.8 
A  =  0.0  A  =  0.7  A  ^  8.3 
T  -=  11.2               T  ^  20.8 

2.  T  =     —  T  =  250  T  =  250 

A  =  62.5  A  =  not  taken     A  =  not  taken 


T  =  22.3 


3.  T  =  —  T  =  500  T  =  500 
A  =  250  A  ^  200  A  —  200 
T  =  22.3  T  =  166.6 

4.  T  -  —  T  -  50.0 

A  =  0.0  A  ==  7.1 


T=  S.6 


A  glance  at  the  above  table  will  show  how  markedly 
the  various  preparations  differed  even  after  a  year's  ex- 
perience. In  the  case  of  the  most  active  one,  No.  3,  the 
firm  made  comparatively  little  improvement  so  far  as  the 
amylopsin  was  concerned,  but  so  far  as  the  more  impor- 
tant trypsin  was  concerned,  it  apparently  multiplied  the 
activity  of  its  injection  by  8.  Even  as  late  as  April, 
1907,  injection  No.  i,  of  which  I  may  at  any  rate  say 
that  it  has  been  very  largely  employed  in  Great  Britain, 
was  extremely  feeble,  and  could  not  be  expected  ever  to 
effect  a  cure.  Of  the  preparations  examined,  only  Nos. 
2  and  3  can  be  regarded  as  substantially  useful. 

Now  let  us  turn  to  another  question  which,  though 


146  THE  CONQUEST  OF  CANCER' 

much  less  important,  is  at  any  rate  of  considerable  inter- 
est for  the  patient.  At  one  time  it  was  supposed  that  the 
injection  of  trypsin  in  a  plain  salt  solution  would  cause 
no  pain  whatever  beyond  the  mere  prick  of  the  needle. 
This  appears,  however,  to  be  not  so.  It  would  seem  that, 
even  when  trypsin  is  so  injected,  the  difference  between 
the  specific  gravity  of  the  solution  and  of  the  blood  is 
sufficient  to  cause  local  disturbance.  Solutions  of  the 
ferments  are  always  of  very  high  specific  gravity.  Be- 
yond this  there  is  the  fact  that  these  ferments  will  not 
keep  in  clear  salt  solution.  More  serious,  however,  from 
this  point  of  view,  seems  to  be  the  glycerine  which  is 
necessary  for  the  preservation  of  the  ferments.  Earlier 
preparations  actually  contained  as  much  as  85  per  cent, 
of  glycerine,  and  20  per  cent,  seems  to  be  the  present 
minimum.  The  attempt  to  substitute  thymol  was  found 
to  cause  more  pain  than  ever.  Worse  than  this,  free 
acetic  acid,  with  which  the  pancreas  is  treated  in  order 
to  convert  its  trypsinogen  into  active  trypsin,  has  actually 
been  found  in  some  of  the  injections,  and  that,  as  every 
student  of  drugs  well  knows,  is  one  of  the  most  painful 
and  powerful  of  local  irritants.  The  addition  of  a  very 
little  bi-carbonate  of  sodium  to  the  solution  will  neutralize 
the  acid;  but  if  this  be  done  the  most  rigid  aseptic  pre- 
cautions must  be  observed.  On  no  account  must  car- 
bonate of  sodium  be  added,  which  promptly  destroys 
these,  like  most  other  ferments.  The  best  of  the  most 
recent  injections,  however,  contain  no  free  acetic  acid. 
For  the  greater  part  of  the  time  that  this  treatment  has 
been  in  employment,  it  has  been  necessary  to  dilute  the 
injections  with  water  in  order  to  lessen  the  pain  caused 
by  the  glycerine  which  they  contain. 

As  we  have  seen,  this  dilution  entails  requirements  as 


PREPARATION  OF  THE  FERMENTS    l^-Tj 

to  sterilization  and  cooling  which  have  too  often  not  been 
met.  It  is  therefore  good  to  be  able  to  state  that  the  best 
of  the  newer  injections  require  no  dilution.  Both  Messrs. 
Fairchild  Bros.  &  Foster  in  New  York — our  indebtedness 
to  whom  from  the  very  first  cannot  be  overstated — and 
Messrs.  Squire  in  London,  appear  to  have  overcome  this 
necessity.  The  solutions  are  still  liable  to  cause  pain  in 
some  cases,  however,  since  it  has  not  yet  been  found  pos- 
sible to  dispense  altogether  with  the  irritant  glycerine. 

At  any  rate  I  make  the  formal  statement  of  the  neces- 
sity for  the  standardization  of  the  preparations  that  are 
put  upon  the  market.  If  one  firm  can  comply  with  this 
requirement,  so  can  others.  It  is  to  be  hoped  that  before 
long  the  chemists  will  be  able  to  do  the  work  which  still 
remains,  so  that  we  may  have  upon  the  market  prepara- 
tions which  are  sterile,  will  keep  for  considerable  periods, 
are  neutral  in  reaction,  contain  no  irritating  substance 
whatever,  and  no  poisonous  peptones,  require  no  dilution, 
and  do  just  so  much  work  as  they  profess  to  do,  neither 
more  nor  less. 

This  question  of  keeping  is  obviously  of  considerable 
importance,  and  too  little  attention  has  yet  been  paid  to  it. 
The  making  of  preparations  from  commercial  trypsin  in 
powder  is  a  most  unsatisfactory  proceeding,  since  this 
is  apt  rapidly  to  lose  its  efficiency.  The  systematic  test- 
ing of  preparations  after  they  are  made  always  shows 
that  this  method  is  of  little  use.  It  was  employed  by 
Von  Leyden.  But  no  less  importance  attaches  to  the 
keeping  of  preparations  even  after  they  have  been  tested 
and  found  satisfactory.  We  must  entirely  condemn  on 
this  account  the  supplying  of  preparations  in  bulk.  Quite 
apart  from  the  question  of  keeping,  intermittent  exposure 
to  the  air  is  involved  in  this  case,  and  condemns  the 


148     THE  CONQUEST  OF  CANCER 

method.  One  dose  in  one  closed  glass  phial  must  be  the 
rule.  On  this  point  Messrs.  Squire  &  Sons  supplied  to 
the  Chemist  and  Druggist^  January  5,  1907,  the  following 
useful  note : — 

"If  it  is  intended  to  distribute  a  solution  throughout 
the  trade  for  the  purposes  of  stock,  such  solution  would 
be  useless  unless  it  would  remain  unimpaired  for  a  year 
or  more ;  but  if  it  is  intended  to  be  supplied,  either  direct 
to  the  doctor,  or  through  the  chemist,  for  immediate  use, 
the  necessity  for  keeping  such  a  long  time  does  not  arise. 
The  pancreatic  ferments  retain  their  properties  better  in 
very  strong  glycerin  menstruum  than  in  any  other  me- 
dium, but  such  solutions  have  drawbacks  not  shared  by 
others.  They  must  be  diluted  before  use  with  sterilized 
water  (which  takes  time),  and  even  then  have  a  tendency 
to  cause  pain  and  inflammation  when  injected,  and  have 
other  serious  disadvantages.  For  these  reasons  it  has 
been  Messrs.  Squire  &  Sons'  practice  to  prepare  solutions 
which  are  intended  for  practically  immediate  use,  and 
they  have  no  complaint  of  the  drawbacks  they  have  in- 
dicated; but  these  solutions  are  not  intended  to  be  put 
away  on  a  shelf  or  in  a  cupboard  and  brought  out  again 
for  use  in  six  months'  time  or  a  year,  under  the  impres- 
sion that  they  will  have  retained  their  full  activity.  Fer- 
ments are  such  delicate  substances  that  every  precaution 
should  be  taken  to  prevent  change  of  their  physiological 
as  well  as  of  their  chemical  nature." 

It  seems  that  even  the  latest  preparations,  even  when 
kept  under  the  best  conditions,  do  not  retain  their  activity 
indefinitely  or  anything  like  indefinitely,  and  probably 
one  month  is  the  limit  of  practical  utility  after  a  prepara- 
tion is  made. 

As  regards  hot  climates,  difficulties  will  be  encountered 


PREPARATION  OF  THE  FERMENTS    149 

which  are  very  nearly  insuperable,  so  far  as  sending  out 
preparations  made  in  England  or  the  United  States  is 
concerned.  At  as  low  a  temperature  as  120°  F.  the 
activity  of  these  preparations  begins  rapidly  to  diminish, 
and  I  am  told  that  the  temperature  of  the  hold  of  a  ship 
in  the  Red  Sea  may  often  be  as  high  as  120°  to 
130°  F.  It  would  seem  to  follow  inevitably  that  the  only 
practical  means,  so  far  as  the  treatment  of  malignant 
disease  in  the  tropics  is  concerned,  will  be  to  have  the 
preparations  made  there.  I  would  emphasize  this  point, 
as  my  advice  has  more  than  once  been  asked  as  to  such 
cases.  A  similar  difficulty  applies  to  Australia,  and  it 
is  rather  doubtful  whether  the  sending  of  preparations 
across  the  Equator  can  be  of  the  smallest  use,  though  the 
Fairchild  preparations  have  done  good  work,  it  is  said, 
in  New  Zealand  and  even  in  Benares. 

One  practical  moral  of  these  facts  as  to  the  keeping  of 
preparations  is  that  not  merely  must  only  standardized 
ferments  be  employed,  but  also  the  practitioner  must  in- 
troduce the  additional  safeguard  of  making  at  least  some 
rough  test  of  their  activity  when  he  employs  them,  if  only 
by  adding  specimens  of  the  trypsin  injection  to  milk,  and 
observing  the  bitter  taste  which  is  produced  by  its  diges- 
tion; and,  in  the  case  of  amylopsin,  by  the  easy  and 
striking  test  with  starch  and  iodine.  Tincture  of  iodine, 
for  instance,  added  to  starch  produces  a  deep  blue  color, 
due  to  the  so-called  iodide  of  starch.  The  previous  treat- 
ment of  the  starch  with  the  amylopsin  preparation  at  the 
temperature  of  the  blood  should  render  the  production 
of  this  coloring  impossible.  I  have  previously  suggested 
that  the  practitioner  would  even  do  well  to  test,  not  the 
injections  from  the  phials  direct,  but  the  material  which 
he  has  already?  drawn  into  his  syringe,  and  which  he  is 


150     THE  CONQUEST  OF  CANCER 

about  to  inject.  For  all  may  be  well  with  the  prepara- 
tion until  the  phial  is  broken,  and  there  may  be  a  slip,  so 
to  speak,  even  between  the  cup  and  the  lip.  This  sug- 
gestion was  the  more  necessary  when  the  preparations 
required  dilution,  but  it  may  be  necessary  even  now 
should  the  practitioner  sterilize  his  syringe  by  heating  it 
and  fail  to  wait  until  it  is  cool  enough  before  he  em- 
ploys it. 

Here  it  would  be  well  to  describe  very  briefly  one,  at 
any  rate,  of  the  sound  methods  which  are  now  employed 
in  the  preparation  of  these  ferments.  Pigs  are  the  ani- 
mals chosen,  their  health  being  certified  by  the  official 
inspector.  The  pancreas-glands  are  collected  and  are 
acted  upon  within,  at  the  latest,  four  hours.  But  even 
here  an  important  point  arises.  The  fact  has  for  some 
time  been  known  that  the  character  of  the  pancreatic 
juice  is  capable  of  considerable  modification.  Says  Prof. 
Moore  {Recent  Advances  in  Physiology  and  Bio-Chem- 
istry, p.  193)  : 

"When  an  animal  is  kept  for  a  long  period  (some 
weeks)  upon  a  definite  and  constant  diet,  the  ferment 
content  of  the  pancreatic  juice  becomes  adapted  to  the 
character  of  the  food.  If,  for  example,  an  animal  which 
has  been  fed  for  some  weeks  entirely  upon  bread  and 
milk  is  brought  on  to  an  exclusively  meat  diet,  which 
in  contrast  with  the  other  diet  contains  more  proteid 
but  scarcely  any  carbohydrate,  it  is  found  that  the  power 
of  the  pancreatic  juice  for  digesting  proteid  increases 
from  day  to  day,  while  the  digestive  power  for  starch 
progressively  diminishes.  On  reversing  the  diet  again 
to  bread  and  milk,  similar  but  inverse  changes  are  ob- 
served." 


PREPARATION  OF  THE  FERMENTS    151 

Hence  even  the  feeding  of  the  pigs  whose  pancreas- 
glands  are  employed  is  a  matter  of  practical  importance. 
I  return  to  this  point  when  discussing  Prof.  Bier's  results 
with  the  ferments  of  pigs'  blood. 

We  must  note  further  that  the  various  preparations  of 
amylopsin  that  have  been  put  upon  the  market  differ 
as  widely  in  their  powers  as  those  of  trypsin.  The  test 
of  activity  in  this  case  has  been  already  referred  to.  Here 
also  the  activity  of  the  preparation  can  be  expressed  in 
units  of  digestive  power,  and  beyond  a  doubt  prepara- 
tions of  this  ferment  also  require  to  be  standardized. 

Lastly,  let  me  add  that  no  one  who  has  any  acquaint- 
ance at  all  with  the  facts  of  these  ferments  can  possibly 
pay  any  attention  whatever  to  negative  results  that  may 
be  published,  in  which  the  activity  of  the  ferments  em- 
ployed was  not  formally  demonstrated,  and  that  in  speci- 
mens taken  at  the  last  possible  moment. 

I  would  devote  the  last  part  of  this  chapter  to  a  series 
of  definite  recommendations  to  manufacturing  and  dis- 
pensing chemxists  regarding  the  preparation  and  distribu- 
tion of  these  ferments.  The  various  competing  firms, 
some  of  whom  are  doing  and  have  done  terrible  harm 
despite  their  good  intentions  and  efforts,  must  renounce 
altogether  solutions  for  injections  of  such  ridiculous 
strengths  as  2  and  5  per  cent.  It  was  the  employment 
of  such  injections  that  brought  discredit  upon  the  treat- 
ment in  its  early  stages.  Quinine  cures  malaria,  but 
quinine  in  doses  of,  say,  one-hundredth  of  a  grain  will 
not  cure  malaria.  These  ferments  are  being  supplied  and 
used  in  doses  just  as  irrelevant  to  the  needs  of  the  case. 
The  manufacturing  chemists  must  put  an  end  to  such 
doses  by  ceasing  to  supply  these  absurdly  weak  solu- 


153     THE  CONQUEST  OF  CANCER 

tions.  Furthermore,  I  would  counsel  them  to  cease  alto- 
gether to  describe  their  preparations  as  consisting  of  such 
and  such  percentages  of  trypsin  or  amylopsin.  They 
must  employ  the  means  which  already  exist  of  standard- 
izing their  preparations.  The  firms  which  cannot  make 
preparations  of  adequate  strength  and  are  unable  to  guar- 
antee in  definite  figures  the  activity  of  what  they  do 
make,  may  be  counseled  in  the  name  of  humanity  to 
leave  these  ferments  alone  altogether,  and  confine  their 
energies  to  aloes  or  cold-cream.  Yet  further^  I  make  the 
demand  that  every  box  containing  these  injections  must 
have  stamped  upon  it  the  exact  date  of  manufacture,  with 
a  further  statement  printed  on  the  outside  of  the  box,  so 
that  doctors,  nurses,  patients  and  friends  may  see  it,  that 
the  contents  are  not  to  be  used  on  any  account  later  than, 
say,  one  month  after  the  date  of  manufacture.  It  should 
also  be  added  that  the  estimated  and  stated  activity  (of 
the  present  preparations)  undergoes  a  rapid  decline  from 
the  very  first  day.  Messrs.  Squire  &  Sons  of  London  have 
marked  every  box  supplied  since  the  beginning  of  the 
present  year  with  the  date  of  the  preparation  of  the  solu- 
tion. The  initials  of  the  responsible  chemist  are  also 
added,  and  the  facts  of  each  box  can  thus  be  ascertained 
on  reference.  This  is  a  most  excellent  example  which 
must  become  the  rule. 

In  my  opinion  all  this  is  absolutely  necessary  in  the 
present  state  of  the  practical  chemistry  of  the  subject. 
It  will  increase  the  expense  of  the  treatment,  but  injec- 
tions which  have  lost  all  their  activity  are  dear  at  the 
price  of  dirt,  and  active  ones  may  prove  worth  their 
weight  in  life.  Yet  further  still,  with  the  injections  must 
be  supplied  prominent  warnings  as  to  the  effect  of  heat 
(and,  I  should  expect,  of  exposure  to  light)  ;  and,  lastly, 


PREPARATION  OF  THE  FERMENTS    153 

I  place  no  trust  in  the  supply  of  injections  in  bulk  either 
to  doctors  or  to  dispensing  chemists.  If  the  precautions 
I  have  formulated  are  attended  to,  it  will  be  impossible 
for  chemists  to  take  in  a  stock  of  these  ferments  and 
rummage  for  them  among  their  shelves  as  they  are  re- 
quired. The  place  for  injections  that  are  not  quite  new 
is  not  the  blood  of  living  men,  but  the  dustbin. 

Parallel  suggestions  may  be  made  to  practitioners.  It 
is  possible  for  them,  if  they  please,  to  compel  the  manu- 
facturing chemists  to  comply  with  these  requirements. 
I  would  warn  them  against  old  injections,  2  per  cent, 
injections  and  the  like,  and  against  any  one  who  offers 
them  trypsin  but  no  amylopsin:  I  would  warn  them 
against  the  use  of  heat  at  any  stage  in  their  technique, 
and  against  the  purchase  of  any  solutions  in  bulk.  The 
pioneer  chemists  in  the  preparation  of  really  efficient  in- 
jections are  Messrs.  Fairchild  Bros.  &  Foster  of  New 
York  (London  agents.  Burroughs,  Wellcome  &  Co.), 
who  have,  of  course,  for  many  years  been  the  pioneers 
in  the  study  of  the  digestive  ferments.  They  will  offer 
the  practitioner  trustworthy  and  extensive  information 
as  to  chemical  details.  The  only  other  firm  of  manufac- 
turing chemists  with  whose  preparations,  so  far  as  I 
know,  any  really  satisfactory  results  have  been  obtained, 
are  Messrs.  Squire  &  Sons,  413  Oxford  Street,  London. 

I  fully  realize  the  responsibility  which  attaches  to  the 
writing  of  this  chapter,  and  at  the  risk  of  tedious  reitera- 
tion I  must  return  to  certain  points  already  discussed. 
It  is  my  desire  completely  to .  suppress,  if  possible,  the 
injurious  activities  of  various  firms  whose  preparations  are 
worse  than  worthless,  and  whose  number  will  doubtless 
soon  be  added  to.  Even  as  I  write  I  receive  a  specimen 
capsule  of  the  (asserted)  tryptic  strength  of  2  per  cent. 


154     THE  CONQUEST  OF  CANCER 

from  a  famous  firm  which  has  not  hitherto  entered  this 
field.  I  only  wish  that  in  dropping  it  into  the  waste-paper 
basket  I  could  dispose  of  all  its  like.  But,  on  the  other  hand, 
there  is  the  risk  that,  in  the  effort  to  put  a  stop  to  the 
sale  of  rubbish,  I  may  hamper  the  firms — of  which,  so  far, 
I  know  only  two — whose  preparations  are  of  real  value, 
and  it  is  in  order  to  avert  this  result  that  the  following 
observations  are  made.  In  the  winter  most  of  them  may 
be  ignored,  but  in  the  hot  weather  the  difficulties,  even 
of  the  pioneer  manufacturers,  are  greatly  increased,  and 
it  would  be  most  disastrous  were  I  to  multiply  them  by 
demanding  the  impossible. 

In  the  first  place,  as  regards  the  question  of  dilution, 
we  must  observe  that  possibly  an  injection  which  does 
require  dilution  at  the  moment  of  injection  may  ulti- 
mately prove  to  be  the  best  adapted  for  the  purpose,  the 
most  potent,  and  the  best  in  "keeping"  qualities.  Against 
such  advantages  the  mere  trouble  of  making  the  dilution 
would  not  weigh  for  a  moment.  My  objection  to  dilu- 
tion, however,  has  no  reference  to  the  trouble  of  making 
it,  nor  to  the  slight  additional  time  involved,  but  solely 
to  the  risk  of  introducing  microbes  which  may  cause 
abscesses.  This  is,  perhaps,  the  least  important  of  the 
risks  involved  in  the  whole  matter.  It  is  nothing  at  all 
to  the  real  risk,  which  is  that  of  using  useless  material ; 
and  the  competent  professional  reader  may  well  accuse 
me  of  rating  too  low  the  skill  even  of  the  least  skilful 
practitioner.  It  is  by  no  means  proved,  indeed,  that  the 
abscesses  which  have  occasionally  followed  injection  were 
due  to  the  dilution.  Experience  borrowed  from  ordinary 
surgical  procedure  would  direct  us  rather  to  criticise, 
the  cleansing  of  the  doctor's  fingers.  Indeed,  it  is  only 
because  the  new  treatment  has  had  to  fight  against  such 


PREPARATION  OF  THE  FERMENTS    155 

incredible  ignorance  and  prejudice  that  I  have  been  com- 
pelled, not  only  here  but  in  my  various  articles,  to  take 
this  question  of  abscesses  so  seriously.  I  have  had  to 
fight  the  belief  that  trypsin  itself  causes  abscesses.  Per- 
haps at  this  stage,  however,  it  might  suffice  to  dismiss  the 
matter  in  a  word  and  take  the  elementary  facts  of  abscess- 
production  for  granted.  There  is  no  more  inherent 
necessity  to  do  otherwise  in  this  case  than  there  is  for  the 
surgeon  who  describes  a  new  form  of  operation.  In  this 
matter,  however,  we  have  had  every  kind  of  factitious 
and  unnecessary  difficulty  to  encounter.  Our  case  has 
been  that  of  the  surgeon  who,  describing  a  new  operation, 
should  be  informed  that  the  operation  has  been  tried, 
that  the  wound  became  septic,  and  that  therefore  the 
operation  is  a  failure  and  he  a  fool.  Then,  as  has  been 
observed  to  me,  to  talk  of  the  risk  of  using  too  hot  water 
in  diluting  the  injection  is  as  if  one  should  talk  of  the 
risk  of  an  operation  by  cutting  into  the  wrong  place ;  and 
I  admit  the  force  of  the  analogy.  But  in  advocating  this 
treatment  I  have  all  along  had  to  fight  just  such  argu- 
ments. 

Thus  the  manufacturing  chemist,  whose  difficulties  are 
far  greater  than  those  of  the  doctor,  is  surely  entitled  to 
say  that  he  declines  to  take  all  sorts  of  chances  as  to  the 
stability  and  activity  of  his  injections  merely  because  there 
is  a  risk  that  some  doctor  may  not  make  the  dilution 
properly.  Such  a  doctor  should  leave  the  treatment  of 
cancer  to  persons  of  ordinary  skill,  and  should  confine 
himself  to,  let  us  say,  spraying  insecticide  solutions  upon 
rose-bushes. 

We  are  only  at  the  beginning  of  this  matter.  It  may 
conceivably  appear  that  the  use  of  an  injection  diluted 
much  beyond  any  hitherto  used  may  be  the  best  pro- 


156     THE  CONQUEST  OF  CANCER 

cedure;  and  in  that  case  my  demand  for  injections  which 
require  no  dilution  is  simply  a  hindrance  to  progress. 
Evidently,  if  of  two  injections  equal  in  digestive  potency 
but  unequal  in  volume,  the  bulkier  is  the  more  readily 
diffused  and  absorbed,  that  is  the  better ;  and  it  may  be 
that  the  chemist  is  unable  to  supply  in  a  stable  form  so 
dilute  an  injection.  In  such  a  case  the  dilution  would 
have  to  be  made  at  the  time  of  use,  and  ordinary  compe- 
tence on  the  doctor's  part  would  have  to  be  assumed. 

During  hot  weather  it  is  possible  that  stable  injections 
requiring  no  dilution — that  is  to  say,  already  diluted — 
cannot  be  prepared ;  or  it  may  be  that  injections  requiring 
no  dilution  can  be  prepared,  but  that  they  will  become 
turbid  in  a  few  days.  The  manufacturer  is  compelled 
to  avoid  this  result,  even  though  he  may  know  that  the 
turbidity  indicates  no  diminution  in  potency,  and  that 
the  injection  is  still  sterile.  He  cannot  give  instructions 
to  filter  the  injection  and  use  the  filtrate,  though  that 
would  be  quite  satisfactory  in  an  ideal  world.  It  would 
not  "work"  in  this  world.  Hence  he  is  compelled,  per- 
haps, to  supply  injections  which  require  dilution.  If  the 
practitioner  will  not  use  such  injections  the  manufac- 
turer's only  alternative  is  to  supply  weaker  injections. 
Perhaps  the  reader  v/ill  now  begin  to  realize  the  nature 
of  the  difiiculties  involved  in  this  subject,  and  also  the 
difficulty  of  the  writer,  whose  duty  it  is  if  possible  to 
make  demands  which  will  suppress  the  irresponsible  pur- 
veyor of  useless  preparations,  while  at  the  same  time 
doing  everything  possible  to  facilitate  the  work  of  the 
conscientious  manufacturer,  without  whom  nothing  can 
be  achieved  at  all. 

On  returning  to  London  after  a  short  holiday,  in 
August,  1907,  I  was  informed  of  a  case  new  to  me,  which 


PREPARATION  OF  THE  FERMENTS    157 

was  under  the  supervision  of  my  friend,  Dr.  Meggitt, 
whose  results  are  noted  elsewhere.  Here,  for  the  first 
time  in  his  experience,  which  began  the  day  after  the 
publication  of  my  article  in  the  Pall  Mall  Gazette  last 
December,  the  treatment  seemed  to  accomplish  nothing 
at  all,  notwithstanding  that  the  case  was  relatively  favor- 
able, though  long  past  all  surgery.  The  doctor  in  charge 
was  keeping  his  injections  in  ice  during  the  warm 
weather,  and  Dr.  Meggitt's  question  to  me  was  whether 
this  might  account  for  the  failure.  Certainly  it  might. 
Some  years  ago,  Prof.  Bayless  of  University  College,  Lon- 
don, showed  that  trypsin  in  solution  soon  becomes  inert 
at  the  freezing-point  of  water,  or  o"  C.  So  here  is  yet 
another  pitfall  which,  but  for  this  accident,  fortunate 
enough  for  all  but  the  patient,  I  should  have  omitted  to 
mention.  I  believe  that  some  firms  of  manufacturers, 
unacquainted  with  the  facts,  have  actually  recommended 
practitioners  to  keep  their  injections  in  ice  during  hot 
weather,  and  this  direction  was  being  followed  in  the 
case  in  question.  It  is  thus  likely  that  the  risk  of  heat, 
insisted  upon,  as  we  are  bound  to  do,  will  tend  to  the  sim- 
ilar risk  of  cold.  Ice  may,  of  course,  be  applied  to  the 
skin  after  injection,  though  that  is  no  longer  necessary ; 
but  injections  must  not  be  kept  in  ice  in  any  weather, 
either  by  the  manufacturer  or  the  chemist  (who  is  better 
without  any  injections  to  keep)  or  the  practitioner.  This 
fact  regarding  trypsin,  which  is  thus  perhaps  more  diffi- 
cult to  keep  than  any  drug  in  the  Pharmacopoeia,  or  any 
!:ind  of  food,  makes  more  unmanageable  than  ever  the 
problem  of  sending  it  to  or  through  hot  countries,  or  of 
manufacturing  it  in  them.  I  am  glad  to  be  able  to  warn 
the    highly    conscientious    and    scrupulous    practitioner 


158     THE  CONQUEST  OF  CANCER 

against  a  risk  to  which  he  especially  would  otherwise  be 
liable. 

It  is  evident  that  a  patient  gets  the  same  dose  of  medi- 
cine whether  he  takes  it  "neat"  or  with  water ;  and  simi- 
larly a  given  dose  of  trypsin  is  taken  whether  water  be 
taken  with  it  or  not.  In  other  words,  a  dose  of  given 
tryptic  potency  will  presumably  have  just  as  much  thera- 
peutic value  when  administered  in  a  hundred  minims  or 
drops  as  in  twenty. 

I  repeat  what  cannot  too  often  be  repeated,  that  the 
whole  matter  is  still  in  the  early  stage,  notwithstanding 
the  magnitude  of  the  results  already  achieved.  It  has 
yet  to  develop,  I  do  not  doubt,  no  less  than  antiseptic 
surgery  has  developed  since  the  late  'sixties.  We  know 
practically  nothing  yet  as  to  the  relative  value  of  various 
kinds  of  injections  any  more  than,  to  use  a  loose  analogy. 
Lord  Lister  knew  in  1868  of  the  relatiA^e  value  of  various 
antiseptics  and  antiseptic  methods.  We  have  yet  to  dif- 
ferentiate between  injections  containing  trypsin  in  its 
normal  associations  with  other  pancreatic  products,  and 
injections  containing  large  proportions  of  amylopsin ;  and 
we  have  yet  to  discover  what,  on  theoretical  grounds,  I 
think  there  may  be, — an  ideal  proportion  that  should  exist 
between  the  two  ferments  in  every  injection.  I  believe 
that  the  present  method  of  using  injections  rich  in  trypsin 
at  first  and  injections  rich  in  amylopsin  later  is  merely 
a  rude  device  for  immediate  needs.  If  cancer  would  hold 
its  hand  for  five  years  we  should  not  need  to  adopt  such 
methods.  But  it  is  evident  that,  on  Dr.  Beard's  theory, 
there  must  be  a  certain  amount  of  amylopsin  which  is  re- 
quired to  complete  the  digestive  processes  initiated  by 
any  fixed  quantity  of  trypsin  in  average  circumstances, 
and    this    proportion    must    be    ascertained.      I    say  "in 


PREPARATION  OF  THE  FERMENTS    159 

average  circumstances,"  because  we  must  not  be  deluded 
into  thinking  that  a  given  quantity  of  a  ferment  can 
only  do  a  finite  quantity  of  work,  as  a  given  quantity 
of  an  acid  will  only  neutralize  a  definite  quantity  of  alkali. 
When  we  can  arrange  all  the  conditions,  a  given  quan- 
tity of  a  ferment  will  do  an  infinite  amount  of  work. 
This  is  one  of  the  standing  marvels  of  ferment  action. 
But  amiongst  the  many  factors  which  we  cannot  arrange 
as  we  would,  at  any  rate  at  present,  in  the  case  in  ques- 
tion, is  the  factor  of  time.  We  know  nothing  as  to  how 
long  a  dose  of  trypsin  remains  in  contact  with  the  sub- 
stance of  a  tumor,  little  as  to  whether,  after  a  time,  it  is 
removed  through  the  venous  or  lymphatic  circulation, 
nothing  as  to  whether  acid  or  other  substances  in  the 
tumor  may  render  it  inert  after  a  time,  nor  how  long  that 
time  is,  nor  what  factors  determine  its  length,  nor  how 
those  factors  vary.  The  all-important  first  step  has  been 
taken  by  Dr.  Beard,  but  there  remains  work  for  many 
a  year  to  come.  We  must  remember  that  chemically 
pure  trypsin  has  never  yet  been  obtained  anywhere,  and 
that,  for  all  we  know,  half  a  dozen  ferments,  each  with 
its  own  specific  powers,  may  be  included  under  what  we 
call  trypsin.  There  is  magnificent  work  yet  to  be  done 
by  the  chemists  in  this  matter ;  and  fifty  years  hence  our 
successors  and  those  of  us  who,  like  the  writer,  may  not 
unreasonably  hope  to  be  still  working,  may  wonder  that 
any  results  at  all  were  obtainable  in  the  present  quite 
rudimentary  state  of  our  knowledge. 


CHAPTER  XIII 

THE  DETAILS  OF  TREATMENT 

I  PROPOSE  in  the  present  chapter  to  discuss  as  fully  as 
possible  everything-  that  has  at  present  been  ascertained 
as  to  the  best  means  of  carrying  out  the  pancreatic  treat- 
ment of  malignant  disease.  By  this  term  I  include  not 
only  cancer,  but  also  sarcoma.  These  two  chief  forms 
of  malignant  disease  cannot  be  regarded,  from  the  pres- 
ent point  of  view,  as  in  any  way  fundamentally  distinct. 
I  confine  myself  to  the  pancreatic  ferments,  not  as  beg- 
ging the  question  of  their  superiority  to  other  ferments, 
but  simply  because  I  believe  them  to  be,  at  any  rate,  the 
most  useful  at  present  g^enerally  available. 

It  is  hardly  necessary  to  say  that  these  directions  are 
not  intended  for  the  public  at  large,  but  for  responsible 
physicians.  No  more  than  the  details  of  antiseptic  sur- 
gery can  the  details  of  this  treatment  be  carried  out  by 
any  one  but  a  trained  physician. 

The  first  necessity  is  to  obtain  suitable  preparations 
for  use.  In  this  respect  there  are  several  competing  firms 
of  chemists.  At  one  time  or  another  it  is  probable  that 
nearly  all  of  these  have  in  good  faith  offered  for  sale 
preparations  which  were  of  no  utility.  At  the  time  of 
writing,  such  preparations  are  certainly  upon  the  mar- 
ket, and  are,  unfortunately,  being  used.  Furthermore, 
there  are  in  use  preparations  which,  though  not  entirely 
inert,  are  far  too  weak  to  be  of  any  real  use,  and  within 

1 60 


THE  DETAILS  OF  TREATMENT        161 

such  a  categor)'^  fall  90  per  cent,  at  least,  I  am  assured, 
of  all  the  injections  that  have  hitherto  been  employed. 

At  present  there  can  be  named  two  trustworthy  firms 
between  whose  preparations  it  is  not  possible  to  make 
any  choice  at  this  time.  One  of  these  has  its  headquar- 
ters in  New  York,  and  the  other  in  London.  Physicians 
and  victims  of  cancer  are  greatly  indebted  to  both  of 
them  for  the  long  and  expensive  researches  which  they 
have  successfully  undertaken.  The  actual  pioneers  in 
the  production  of  effective  preparations  were  undoubtedly 
Messrs.  Fairchild  Bros.  &  Foster,  Fairchild  Building, 
Laight  Street,  New  York  City.  It  will  be  familiar  to 
many  readers  that  for  years  past  this  firm  has  specialized 
in  the  preparation  of  the  digestive  ferments  for  medical 
purposes,  and  their  long  experience  has  unquestionably 
been  of  the  utmost  value  to  the  new  treatment.  Undoubt- 
edly, a  part  explanation,  though  by  no  means  the  whole, 
of  the  fact  that  results  were  obtained  in  America  at  a 
date  relatively  so  early  is  to  be  found  in  the  fact  that 
Messrs.  Fairchild's  preparations  were  exclusively,  or  al- 
most exclusively,  used  across  the  Atlantic  from  the  first.^ 
But  until  the  present  year,  if  not  still,  the  best  prepar- 
ations obtainable  in  Europe  were  also  Fairchild's,  deteri- 
orated inevitably  by  their  transatlantic  journey. 

The  English  firm  which  has  contributed  to  the  per- 

^London  Agents  and  Foreign  Depots  of  "The  Fahichild  Prep- 
arations'" : 

Burroughs,  Wellcome  &  Co.,  Snow  Hill  Buildings,  London. 

Burroughs,  Wellcome  &  Co.,  14  Via  Carlo  Alberto,  Milano, 
Italy. 

Scott  &  Co.,  4   Rue  Chauveau-Lagarde,  Paris,  France. 

E.  Nadolny,  Spitalstrasse   9,  Basle,  Switzerland. 

Ch.  Delacre  &  Co.,  50-52   Rue  Coudenberg,  Brussels,  Belgium. 

Linkenheil  &  Co.,  Genthinerstrasse   19,  Berlin,  Germany. 


162     THE  CONQUEST  OF  CANCER 

fecting  of  the  preparations  is  that  of  Messrs.  Squire  & 
Sons,  413  Oxford  Street,  London,  W.  Their  experi- 
ments, carried  out  in  December,  1906,  and  the  three  fol- 
lowing months,  were  of  the  utmost  value,  and  upon  them 
was  based  the  demand  for  the  standardization  of  the  prep- 
arations which  I  made  in  America  in  March,  1907. 

We  may  still  retain  the  proposition  that  the  complete 
treatment,  where  possible,  is  threefold — hypodermal,  oral 
and  local.  I  will  deal  with  the  oral  treatment  first.  This 
has  hitherto  been  considered  the  least  important,  and  for- 
merly I  have  discussed  it  curtly. 

It  still  is  true  that  the  attempt  to  treat  cancer  by  the 
oral  administration  of  the  pancreatic  ferments  alone  is 
little  better  than  a  farce,  as  it  is  usiiaUy  made,  though  this 
statement  must  be  modified  in  the  light  of  Von  Leyden's 
work  as  regards  cancer  of  the  stomach.  Trypsin  is  liable 
to  be  destroyed  with  very  great  rapidity  in  the  stomach, 
in  accordance  with  the  general  principle  that  even  weak 
solutions  of  acids  rapidly  destroy  all  ferments,  with  the 
notable  exception  of  pepsin.  In  so  far,  then,  as  any  kind 
of  good  is  to  be  expected  from  the  oral  administration 
of  this  ferment,  it  must  be  administered  before  meals — 
say  an  hour  before  food — at  a  time  when  the  stomach 
probably  contains  no  free  hydrochloric  acid.  We  may 
hope  that,  thus  administered,  the  ferment  will  pass  on 
into  the  bowel  undestro3^ed. 

Now,  everything  which  makes  for  the  better  health  and 
nutrition  of  the  patient  is  of  value.  As  a  rule,  there  has 
been  great  loss  of  weight,  and  this  has  to  be  recovered 
whilst  absorption  of  the  growth  occurs,  this  absorption 
in  itself  tending  to  interfere  with  the  patient's  nutrition. 
Thus  quite  apart  from  any  hypothesis  as  to  inactivity  of 
-the  pancreas  in  such  cases — of  which  we  have  no  evi- 


THE  DETAILS  OF  TREATMENT        163 

dence — we  may  be  assured  that  the  oral  use  of  pancreatic 
extract  before  meals  may  aid  the  digestion,  and  thus  the 
general  nutrition.  This  is  no  negligible  service,  though 
as  such  it  has  no  bearing  whatever  upon  the  history  of 
the  tumor  from  which  the  patient  is  suffering. 

Formerly  I  used  to  state  that  the  simple  administra- 
tion of  the  ferments  by  the  mouth  could  not  be  expected 
to  have  any  really  remedial  action.  I  argued  that  there 
was  no  positive  evidence  to  show  that  active  trypsin  in 
the  bowel,  whether  formed  there  from  trypsinogen  in  the 
natural  manner,  or  reaching  it  from  the  mouth,  is  ab- 
sorbed into  the  blood.  No  doubt  such  absorption  occurs 
in  the  empty  bowel  before  birth,  when — as  has  been  lately 
proved  again  by  Barbera — trypsin  is  formed  in  it,  as 
after  birth ;  but  there  was  no  evidence  that  after  birth 
such  absorption  occurred.  Thus  it  seemed  most  essential 
not  to  recognize  mouth  administration  as  a  serious  and 
effective  method.  If  trypsin  had  been  demonstrated  as 
normally  present  in  the  blood,  the  case  would  have  been 
different ;  but,  so  far  from  this,  the  physiologists  taught — 
erroneously,  as  we  now  know — that  the  injection  of  tryp- 
sin into  the  blood  promptly  leads  to  the  production  of  an 
anti- ferment. 

The  recent  German  work  has  greatly  altered  our  con- 
ceptions on  this  point.  Prof.  Von  Leyden  has  recovered 
active  trypsin  from  the  urine  after  its  administration  by, 
the  mouth — conclusive  proof  of  its  absorption  into  the 
blood  from  the  bowel.  (Absorption  of  anything  but 
water  from  the  stomach  scarcely  occurs  at  all.)  In  the 
absence  of  any  such  supposition  as  that,  in  cancer,  the 
bowel  is  modified  in  some  way  so  as  to  interfere  with 
the  absorption  of  trypsin,  it  therefore  follows  that  the 
oral  administration  of  trypsin  should  be  a  perfectly  effect- 


164     THE  CONQUEST  OF  CANCER 

ive  mode  of  treatment;  and  in  point  of  fact  I  have  word  of 
a  case,  as  yet  unreported,  in  which  oral  administration 
alone  did  prove  quite  effective.  It  would  seem  that,  if  once 
the  trypsin  passes  safely  through  the  stomach,  where 
hydrochloric  acid  is  too  frequently  lying  in  wait  to  de- 
stroy it,  its  absorption  into  the  blood  should  be  effected. 
Now  it  is  absorption  into  the  blood  that  is  the  whole 
object  of  the  hypodermic  administration  of  the  ferment, 
and  it  matters  not  at  all,  of  course,  whether  this  absorp- 
tion occurs  from  the  bowel  or  from  the  subcutaneous 
tissues.  It  is  further  to  be  noted  that  the  risk  of  gastric 
destruction  of  trypsin  is  less  in  cancerous  than  in  healthy 
patients,  since  the  secretion  of  hydrochloric  acid  by  the 
stomach  is  diminished  or  suspended  not  merely  in  cancer 
of  the  stomach,  as  used  to  be  taught,  but  in  cancer  gen- 
erally. In  any  case  this  risk  can  be  averted,  and  it  is 
conceivable  that  the  adequate  administration  of  trypsin 
by  the  mouth  may  prove  itself  capable  of  replacing 
altogether  the  hypodermic  method  of  administration ;  and 
also  that  here  we  may  have  a  simple,  convenient,  painless 
method  of  preventing  the  development  of  cancer  in  per- 
sons in  whom  it  is  threatened.  At  present  one  can  only 
say  that,  if  it  be  possible  to  do  without  hypodermic  in- 
jection, complicated  as  it  is  by  so  many  chemical  difficul- 
ties and  immediate  inconveniences,  we  shall  have  infinite 
reason  to  be  grateful.  Even  now,  however,  the  demon- 
stration of  \^on  Leyden  demands,  as  an  immediate  prac- 
tical corollary,  that  the  extensive  use  of  active  trypsin 
by  the  mouth  should  always  be  practiced  as  a  necessary 
part  of  the  treatment.  If,  as  I  suspect,  the  factor  of 
time  is  important,  as  it  is  in  the  case  of  such  drugs  as 
sodium  salicylate,  which  is  excreted  by  the  kidneys  with 
extreme  rapidity,  then,  as  in  that  case,  it  is  desirable  to 


THE  DETAILS  OF  TREATMENT        165 

administer  the  remedy  at  intervals  far  more  frequent  than 
is  practicable  with  hypodermic  injection.  Certainly  if  I 
believed  myself  to  have  a  cancer,  or  symptoms  suggesting 
the  presence  of  the  disease,  I  should  forthwith  put  myself 
upon  large  doses  of  trypsin,  taken  at  least  three  times  a 
day  on  an  empty  stomach,  whatever  other  measures  I 
sought  to  employ.  It  may  be  desirable  to  neutralize  the 
possible  (organic,  not  hydrochloric)  acidity  of  the  stom- 
ach, which  in  dyspepsia — such  as  is  common  in  cancer 
— may  have  continuously  acid  contents,  by  giving  sodium 
bicarbonate  before  the  trypsin.^ 

The  local  treatment  is,  of  course,  not  applicable  in  all 
cases,  but  those  who  are  acquainted  with  the  general  facts 
of  cancer  will  realize  that  in  the  majority  of  cases  it  is 
available,  even  in  cases  where  no  ulceration  has  occurred. 
Thus  in  cancer  of  the  mouth  and  tongue  and  lip  and 
cancer  of  the  womb,  local  applications  of  the  pancreatic 
ferments  are  possible.  Again  I  would  insist  that  these 
cannot  be  expected  to  affect  the  deeper  parts  of  the  tumor, 
which  are  the  parts  where  extension  and  invasion  of  the 
healthy  tissues  are  chiefly  occurring.  Nor  can  local  appli- 
cation be  expected  in  any  way  to  interfere  with  the  occur- 
rence of  secondary  tumors  by  means  of  the  passage  of 
malignant  cells  through  the  lymphatic  vessels  or  the 
veins.  Nevertheless  such  local  treatment  in  many  cases 
effects  the  very  rapid  digestion  and  disappearance  of 
great  quantities  of  tumor  tissue,  and  does  so  in  a  manner 
infinitely  preferable  to  that  only  too  commonly  effected 
by  the  growth  of  microbes  upon  it.  Nothing  could  have 
been  more  remarkable  than  the  results  in  the  first  case  I 

'^Certain  of  the  oral  preparations  are  most  nauseous  and  actually 
upset  the  digestion — a  strange  effect  of  digestive  ferments.  The 
glycerine,  etc.,  in  such  must  somehow  be  dispensed  with. 


166     THE  CONQUEST  OF  CANCER 

witnessed,  now  nearly  two  years  ago,  which  followed 
the  local  application  of  lotto  pancreatis.  Wherever  a 
swab  soaked  in  this  preparation  was  applied  the  tumor 
simply  melted  away.  It  need  hardly  be  pointed  out  that 
it  is  much  better  for  the  patient  to  have  a  given  quantity 
of  malignant  tissue  thus  disposed  of,  than  to  have  the 
products  of  its  digestion  absorbed  into  his  blood.  Both 
liquid  and  solid  preparations  for  local  use  may  be  ob- 
tained, and  I  would  strongly  insist  that  these  should  be 
employed  wherever  their  use  is  practicable.  Though 
their  employment  will  cure  no  cancer,  except  possibly 
very  superficial  tumors  of  the  skin,  they  constitute  most 
valuable  aids  to  the  treatment.  Let  it  be  observed  that 
the  local  use  of  these  ferments  does  not  cause  pain,  that 
it  does  not  in  any  way  affect  normal  tissues,  and  that  it 
is  in  no  way  comparable  to  the  use  of  caustics,  such  as 
caustic  potash,  arsenic  and  the  like.  The  practitioner 
may  still  be  troubled  for  some  time  to  come  by  signs  of 
local  irritation  caused  by  the  glycerine  and  acetic  acid 
contained  in  certain  of  the  washes  sold  for  local  use. 

I  now  pass  to  the  essential  part  of  the  treatment,  which 
is  the  hypodermic  or  subcutaneous  injection  of  active 
preparations  of  the  two  pancreatic  ferments,  trypsin  and 
amylopsin.  "The  amylopsin,"  says  Dr.  Beard,  "is  spe- 
cially meant  to  be  used  in  the  later  periods  of  treatment, 
to  help  to  clear  away  the  remains  of  dead  tumor ;  but 
from  the  start  it  should  be  given  against  any  bad  symp- 
toms, such  as  nausea,  vomiting,  pain  in  the  back,  drowsi- 
ness, high  arterial  tension,  albuminuria,  and  cedema  gen- 
erally. Bad  symptoms,  which  are  not  always  prominent 
features,  bear  resemblances  to  eclampsia,  and  are  due  to 
the  like  cause, — products  of  degenerating  trophoblast  (tu- 
mor).    In  uterine  and  abdominal  cases  in  general  it  is 


THE  DETAILS  OF  TREATMENT        167 

advisable  to  give  an  injection  of  amylopsin  twice  weekly 
from  the  start."  This  question  is  further  discussed  in 
another  chapter. 

The  hypodermic  injections  may  be  made  anywhere,  but 
not  into  the  tumor  mass — as  made  by  Prof.  Von  Leyden 
— ^where  they  are  apt  to  cause  considerable  swelling  and 
pain.  Dr.  Beard  has  made  this  recommendation  from 
the  very  first,  and,  indeed,  in  the  preparation  of  this 
whole  chapter  I  am  greatly  indebted  to  the  general  direc- 
tions for  treatment  which,  since  the  early  part  of  1906, 
he  has  freely  sent  to  every  physician  who  has  written 
to  him. 

The  injections  must  not  be  made  into  muscular  tissue, 
where  the  injections  hitherto  supplied  are  liable  to  cause 
much  pain,  nor,  if  possible,  should  they  be  made  imme- 
diately under  the  skin,  and  for  the  same  reason.  If  pos- 
sible they  should  be  made  into  the  fatty  subcutaneous 
tissue,  though  this  is  only  too  frequently  wasted  in  pa- 
tients suffering  from  cancer.  The  arm,  especially  the 
upper  arm,  and  the  buttock,  are  the  sites  most  frequently 
chosen.  The  neighborhood  of  the  backbone  must  be 
avoided.  For  reasons  undivulged,  the  Middlesex  Hos- 
pital observers  chose  the  tender  skin  of  the  abdomen — 
with  the  disastrous  results  which  they  record. 

The  skin  at  the  site  of  injection  must  be  scrupu- 
lously cleansed  and  sterilized.  A  little  eucaine  or  other 
local  antiseptic  may  be  employed  in  order  to  lessen  the 
pain  of  the  injection  in  the  case  of  nervous  or  sensitive 
patients.  The  greater  part  of  the  discomfort,  however, 
so  far  as  I  have  observed,  is  due  not  so  much  to  the 
piercing  of  the  skin  by  the  injection-needle,  as  to  its 
distention  when  the  fluid  is  forced  under  it.     This   is 


168     THE  CONQUEST  OF  CANCER 

another  reason  why  injection  into  the  loose  subcutaneous 
tissue  is  preferable. 

So  far  as  has  been  at  present  observed,  there  is  a 
marked  difference  between  the  painfulness  of  the  two 
injections.  The  amylopsin  causes  very  little  local  trouble 
indeed,  if  any.  The  trypsin,  however,  is  apt  in  many 
patients,  to  give  rise  to  some  swelling,  local  discomfort 
and  pain.  This  depends  not  at  all  upon  any  inherent  dif- 
ference in  the  relations  of  the  two  ferments  to  normal 
tissues,  but  merely  upon  the  different  mode  of  prepara- 
tion which  is  employed  in  the  two  cases.  A  firm  lump 
may  sometimes  form  at  the  site  of  injection,  which  will 
not  disappear  for  some  days.  It  has  been  suggested  that 
eucaine  should  be  injected  immediately  after  the  ferments, 
but  it  is  doubtful  whether  this  is  necessary,  and  the  fur- 
ther question  has  to  be  asked  whether  eucaine  has  any 
adverse  influence  upon  the  ferments.  The  best,  simplest, 
and  most  effective  procedure  is  to  use  ice.  When  the 
injections  are  made  into  the  arm,  pieces  of  ice  may  con- 
veniently be  bound  upon  it  and  kept  there  for  even  so 
long  as  two  or  three  hours,  being  renewed  if  necessary. 
This  gives  the  greatest  relief  and  comfort  in  every  in- 
stance, and  until  injections  which  cause  no  pain  can  be 
prepared,  the  use  of  ice  should  be  employed  as  a  routine 
procedure.  Lately  it  has  been  my  experience  that  the  ice 
is  no  longer  necessary. 

The  syringe  is  best  made  entirely  of  glass,  and  must  be 
rigorously  sterilized.  For  this  purpose  heat  is  often 
employed.  If,  however,  the  syringe  be  boiled,  it  must 
be  cooled  before  the  injection  is  sucked  into  it.  On  no 
account  whatever  must  the  injection  be  exposed  to  heat, 
which  will  rapidly  destroy  the  trypsin  and  render  the 
whole  proceeding  futile.    I  have  seen  perfect  success  fol- 


THE  DETAILS  OF  TREATMENT        169 

low  the  sterilization  of  the  syringe  by  means  of  the  suc- 
cessive employment  of  perchloride  of  mercury  (i  in 
i,ooo),  boracic  acid,  and  sterilized  distilled  water.  This 
is  not  so  troublesome  as  it  sounds,  and  avoids  any  risk 
that  impatience  may  lead  to  the  use  of  the  syringe  when 
it  is  too  hot. 

Some  of  the  injections  still  upon  the  market  require 
dilution.  This  is  a  defect,  because  it  leads  to  risk  of  two 
kinds  in  the  hands  of  careless  practitioners.  The  water 
used  for  dilution  may  be  insufficiently  cool,  or  may  be 
imperfectly  sterilized.  The  water  to  be  used  must  be 
sterile,  cool,  and  distilled.  If  it  be  sterilized  by  boiling, 
on  no  account  whatever  must  its  cooling  be  hastened  by 
adding  the  cold  injection  to  it.  One  might  as  well  omit 
to  add  the  injection  altogether  as  destroy  it  by  heat  in 
this  fashion. 

Sa3's  Dr.  Beard:  "The  greatest  care  and  cleanliness 
should  obtain,  and  the  dose  should  be  graduated  with  care- 
ful regard  to  the  reactions  observed.  The  course  of  the 
treatment  should  be :  Injectio  trypsini,  full  doses  up  to 
two  ampoules  daily  for  four  weeks;  then  Injectio  trypsini 
and  Injectio  amylopsini  alternately  on  different  days  for 
ten  to  twelve  weeks  and  longer  in  the  same  way,  and  in 
doses  of  one  to  two  ampoules ;  and,  finally,  Injectio  amy- 
lopsini alone  daily,  or  every  other  day,  for  four  weeks, 
and  longer,  in  doses  of  one  to  two  ampoules. 

"N.B. — It  is  impossible  at  present  to  state  any  exact 
period  for  giving  the  alternate  injections  of  trypsin  and 
amylopsin.  The  time  will  vary  in  .  different  cases,  but 
the  use  of  trypsin  should  not  willingly  be  stopped  entirely, 
for  although  the  main  mass  of  a  tumor  may  appear  to  be 
dead,  there  may  still  be  a  few  living  cells  within.  More- 
over, the  possible  existence  of  metastases  should  not  be 


170     THE  CONQUEST  OF  CANCER 

overlooked.  The  physician  must  he  certain  the  tumor  is 
all  dead  before  he  relies  on  injections  of  amylopsin  alone." 

To  this  Dr.  Beard  now  adds :  "With  very  many  post- 
operative recurrent  cases  no  amount  of  dose  will  have 
any  effect  in  stopping  the  tumor  from  'running  its  para- 
bola.' Success  may  come,  but  it  cannot  be  anticipated 
with  certainty  in  post-operative  recurrent  cases.  The 
treatment,  as  a  scientific  one,  is  not  really  intended  for 
such  cases,  for  it  is  not  scientific  to  operate  upon  living 
cancer  or  asexual  generation."  (I  believe,  myself,  that 
this  decidedly  understates  the  power  of  the  treatment, 
even  in  post-operative  cases.)  "The  'X'  rays  should  not 
be  used  along  with  this  treatment.  The  period  of  stop- 
page of  the  injection  of  amylopsin  will  also  vary  in  dif- 
ferent cases.  Where  much  dead  tumor  remains,  it  may, 
and  should,  be  given  indefinitely,  as  long  as  any  remains 
persist,  in  daily  doses,  or  every  other  day,  and  its  use 
should  not  be  willingly  given  up.  If  for  any  reason  it 
be  dropped,  a  careful  watch  must  be  set  upon  the  patient, 
and  on  the  appearance  of  headaches,  drowsiness,  loss  of 
appetite,  nausea  or  vomiting,  or  other  bad  symptoms,  its 
use  must  at  once  be  resumed,  in  doses  and  at  intervals 
in  the  discretion  of  the  physician.  In  malignant  sarcoma 
much  more  vigorous  treatment  may  be  needed,  at  any 
rate  for  a  time,  until  the  tumor  be  killed  (not  after),  for 
I  have  known  as  many  as  sixty  ampoules,  injected  two 
daily,  to  produce  no  effects  on  a  sarcoma." 

This  whole  question  of  dosage  is  a  most  important  and 
difficult  one.  The  doses  employed  during  the  first  year 
of  the  treatment  were  always  believed  and  maintained, 
both  by  Dr.  Beard  and  myself,  to  be  utterly  inadequate, 
quite  apart  from  any  question  as  to  their  not  being  what 
they  purported  to  be.    It  is,  of  course,  relatively  easy  for 


THE  DETAILS  OF  TREATMENT        171 

the  non-practitioner,  who  is  not  directly  responsible  for 
any  patient,  to  make  this  criticism.  The  vast  majority  of 
those  who  have  used  the  treatment,  even  where  they  have 
employed  active  preparations,  and  employed  them  prop- 
erly, have  used  ridiculously  inadequate  doses.  This  has 
by  no  means  been  entirely  their  fault.  The  earlier  prepa- 
rations put  upon  the  market  were  such  that  adequate 
doses  of  them  would  have  been  so  bulky  as  to  be  almost 
impracticable.  The  case  is  very  different  now.  Apart 
from  this,  however,  many  have  had  a  superstitious  fear 
of  the  ferments,  and  have  gone  on  using  doses  which  no 
one  could  well  expect  to  be  effective,  even  though  no 
symptoms  of  any  kind  were  obtained.  The  so-called  2 
per  cent,  strength  of  trypsin,  for  instance,  which  one 
practitioner  recommends,  is  ludicrously  inadequate.  ''Till 
we  know  more  of  this  toxic  agent,  it  should  be  used  with 
care,"  says  Dr.  Shaw  Mackenzie ;  and  it  is  this  entirely 
false  conception  of  trypsin  which  has  disastrously  inter- 
fered with  the  success  of  the  treatment,  by  leading  prac- 
titioners to  employ  doses  of  homoeopathic  tenuity,  and 
then  declare  that  no  result  is,  or  can  be,  obtained. 

We  must  cease  entirely  to  use  any  unit  of  dosage  other 
than  units  of  digestive  capacity.  We  can  go  neither  by 
number  of  drops  nor  by  asserted  percentages  of  the  fer- 
ments. Questions  of  dosage  must  be  discussed  in  terms 
precisely  similar  to  those  employed  in  the  case  of  the 
treatment  of  diphtheria  by  the  anti-toxin.  It  seems  prob- 
able, then,  that  a  safe  and  effective  dose  is  one  containing 
five  hundred  units  (Roberts)  of  tryptic  activity  and  two 
hundred  of  amylolytic  activity :  most  certainly  not  less. 
This  proportion  between  the  two  ferments  seems  to  be 
the  most  useful  one.  Injections  of  pure  trypsin  (free 
from  amylopsin)  should  never  be  employed  at  all.     Such 


173     THE  CONQUEST  OF  CANCER 

injections  are  not  obtainable,  and  I  hope  the  manufactur- 
ers will  not  attempt  to  produce  them.  Such  a  dose  as  I 
have  named  is  contained  in  one  cubic  centimeter — that 
is  to  say,  about  seventeen  drops — of  Messrs.  Squire's 
preparation,  which  they  call  Standard  II.  This  requires 
no  dilution,  and  its  bulk  is  relatively  so  small  that  it  can- 
not be  expected  to  cause  much  local  disturbance.  As 
for  the  amylopsin,  a  dose  of  two  hundred  units,  comprised 
in  the  same  bulk,  seems  to  be  a  satisfactory  one. 

As  to  the  time  periods  named  by  Dr.  Beard  above,  they 
can  only  be  regarded  as  giving  some  indication  for  early 
cases.  In  the  advanced  cases  which  have  exclusively 
come  under  this  treatment  hitherto,  much  more  pro- 
longed administration  has  been  necessary.  On  the  other 
hand,  much  shorter  administration  has  sufficed  for  the 
destruction  of  a  small  nodule — even  though  recurrent — 
such  as  that  reported  by  Prof.  W.  J.  Morton  in  the  New 
York  Medical  Journal,  March  9,  1907. 

I  quote  further  from  Dr.  Beard:  "The  question  of 
proper  dosage  is  not  yet  decided  finally,  and  it  will  prob- 
ably be  found  to  vary  with  the  different  cancers.  In  the 
foregoing  I  have  preferred  to  err  on  the  safe  side  (in 
advising  sufficient  for  an  ordinary  cancer,  not  a,sarcoma). 
In  some  cases,  and  in  small  epitheliomata,  no  doubt  less 
would  suffice.  While  the  tumor  is  alive,  and  for  some 
little  time  after,  it  may  be  taken  that  the  cancer-ferment, 
malignin,  and  the  pancreatic  ferments,  especially  trypsin, 
act  toward  each  other  somewhat  like  toxin  and  anti-toxin. 
The  killing  of  the  cancer-cells  of  any  ordinary  unoper- 
ated  cancer,  if  not  large,  is  not  at  all  difficult.  Indeed, 
it  may  be  brought  to  pass  in  less  than  a  month.  The  real 
difficulty,  then,  arises  in  the  removal  of  the  remains  of 
the  dead  tumor.     If  this  be  left  to  treatment,  and  be  not 


THE  DETAILS  OF  TREATMENT        175 

done  surgically,  it  may  be  a  matter  of  many  months,  dur- 
ing which  the  use  of  trypsin  and  amylopsin  (injections) 
must  be  kept  in  view  at  all  times.  In  a  successful  Italian 
case  of  inoperable  cancer  of  the  tongue  (of  three  years' 
standing),  it  may  be  taken  that  full  treatment  began  at 
the  end  of  February,  1906,  stopped  about  the  middle  of 
June,  1906,  but  the  final  remains  of  the  tumor  only  took 
their  departure  at  the  end  of  September,  1906.  Atten- 
tion should  be  paid  to  a  good,  liberal,  nourishing  diet, 
with  plenty  of  water  and  milk  to  drink.  For  a  few  weeks 
at  the  start  salts  and  acids  should  be  avoided. 

"Signs  of  improvement  usually  appear  after  some  ten 
injections.^  They  are:  cessation  of  pain,  increase  of 
strength,  improved  appearance,  loss  of  discharge  (if  any), 
unless  the  tumor  be  sloughing  away,  loss  of  smell  (if 
any),  and  soon  marked  shrinking  and  softening  of  the 
tumor-mass.  The  treatment  should  not  be  dropped  for 
a  time,  for  there  is  danger,  especially  in  the  first  three 
months,  of  the  formation  of  poisonous  substances  from 
the  degenerating  tumor." 

It  is  necessary  to  insist  again  upon  the  entirely  tenta- 
tive and  provisional  character  of  this  whole  chapter.  If 
our  critics  and  those  who  have  failed  had  carefully  pub- 
lished their  experiences,  or  anything  fairly  to  be  called 
criticism  (i.e.  judgment),  we  should  doubtless  know 
much  more  now.  But  this  innovation  has  not  received 
from  the  conservative  that  enlightening  criticism  which 
is  at  all  times  the  humble  but  necessary  function  of  con- 
servatism. The  central  question  of  dosage  remains  quite 
undetermined,  and  will  so  remain  until  nothing  but  stand- 
ardized preparations,  used  within  a  standardized  time 
limit,  are  employed.  In  the  case  of  recurrent  sarcoma 
'Much  sooner  with  the  best  injections  in  my  recent  e^perience. 


IT*  THE  CONQUEST  OP  CANCER 

to  whicH  Dr.  Beard  refers,  for  instance,  no  one  can  say 
how  much  active  trypsin  was  actually  employed.  Far 
smaller  "doses"  have  brought  a.  recurrent  sarcoma  under 
control  and  destroyed  it,  as  in  Dr.  Doran's  case  (noted 
later) .  But  these  doses  may  actually  have  been  far  larger 
than  those  in  the  case  of  failure. 

Nevertheless,  it  is  impossible  to  exclude  the  exceed- 
ingly probable  supposition  that  ultimately  the  necessary 
dosage — actual,  not  nominal — will  be  found  to  vary  with 
different  types  of  growth.  Elsewhere  I  discuss  such 
a  priori  data  as  we  at  present  possess  in  this  relation ;  a 
posteriori  data  there  are  as  yet  substantially  none. 

I  do  not  doubt  that  the  questions  of  abscess  formation, 
and  of  destruction  of  the  ferments  by  heat  at  any  stage, 
are  subsidiary  as  causes  of  failure,  compared  with  inade- 
quacy of  dosage  due  to  other  causes.  Absolutely  ridicu- 
lous percentages — and  these  only  nominal — ^have  been 
employed.  Such  preparations  should  not  be  even,  ob- 
tainable ;  for  any  fraction  of  any  preparation  can  be  used 
if  desired.  Similarly,  inadequate  doses  even  of  adequate 
preparations  have  been  used.  It  is  incomprehensible  how 
practitioners,  having  nothing  else  in  the  world  to  offer 
their  patients,  have  given  the  new  treatment  the  sort  of 
perfunctory  and  farcical  trials  to  which  at  least  two 
great  hospitals  in  London  have  publicly  confessed.  If 
results  are  not  obtained  at  first,  and  neither  constitutional 
symptoms  nor  results  show  in  the  growth  itself,  the  dose 
must  be  rapidly  increased.  In  any  case,  the  practitioner 
does  not  know  what  doses  he  is  really  giving,  unless  he 
employs  a  standardized  injection  made  the  same  day. 
He  is  accustomed,  of  course,  to  employ  that  poison- 
therapeutics  which  has  held  sway  in  medicine  for  so 
many  ages  and  is  now  doomed ;  and  his  experience  with 


THE  DETAILS  OF  TREATMENT        175 

the  poisons  of  his  daily  employment  teaches  him  to  be- 
ware of  an  overdose,  and  to  beHeve  in  an  upper  Hmit  of 
safety  for  everything  he  uses.  Trypsin  proves  by  its 
origin  in  each  of  us  that  it  is  not  a  poison:  the  German 
workers  have  proved  that  enormous  doses  cause  no  symp- 
toms in  the  lower  animals  (free  from  cancer),  even  when 
injected  into  the  blood :  if  and  when  the  injection  causes 
constitutional  symptoms  these  coincide  with,  as  they  de- 
pend upon,  favorable  changes  in  the  tumor :  and  these 
symptoms  can  be  controlled  by  amylopsin.  When  no  re- 
sults of  any  kind  appear,  either  the  disease  is  not  cancer 
at  all,  but  an  innocent  tumor,  an  inflammatory  swelling 
or  what  not ;  or  else  the  injection  is  inert ;  or  else  the 
growth  may  be  of  a  type  so  malignant — whether  from 
the  first  or  as  the  result  of  operation — that  its  ferment 
cannot  be  mastered  by  trypsin ;  or  else  the  dosage  is  too 
small.  Having  no  other  recourse  In  the  world,  the  prac- 
titioner is  surely  bound  to  investigate  the  activity  of  his 
preparations,  and,  if  no  symptoms  result,  to  increase  the 
dose  rapidly.  There  is  no  toxic,  still  less  a  lethal,  dose 
of  trypsin  as  such,  though  there  may  be  doses  indirectly 
toxic  to  cancer  patients.  In  the  absence  of  toxic  symp- 
toms (which  are  not  due,  and  cannot  possibly  be  due,  to 
its  direct  action,  but  are  the  index  of  its  desired  activity) , 
the  dose  must  be  increased.  Any  one  with  any  experi- 
ence of  the  treatment  will  recognize  at  once  that  the  fail- 
ure of  the  Middlesex  Hospital  observers — which  has  so 
potently  swayed  opinion  in  Great  Britain,  and  which  one 
or  two  enemies  of  trypsin,  seeking  to  bolster  up  their 
early  statements,  have  exploited  and  more  than  exploited 
in  America — was  in  all  probability  due  partly  to  the  small- 
ness  of  the  doses  employed.  Nominally  the  doses  were 
evidently  far  too  small:  actually  doubtless  far  smaller. 


176     THE  CONQUEST  OF  CANCER 

But  an  experienced  observer,  uninformed  as  to  the  doses 
employed,  and  the  surgical  histories  of  the  cases — which 
last  are  not  stated — would  at  once  condemn  them  as 
inadequate  from  the  mere  fact  of  the  absence  of  consti- 
tutional and  local  reaction  (in  the  tumor.  There  was 
most  abundant  local  reaction  at  the  site  of  injection.) 
This  instance  shows  the  importance  of  avoiding  assump- 
tions of  futility  when  testing  a  treatment.  If  the  ob- 
server is  not  a  skeptic  he  attributes  failure  possibly  to 
himself,  and  modifies  his  method.  If  he  is  a  skeptic — or, 
rather,  an  active  disbeliever — ^he  attributes  his  failure  to 
the  inherent  futility  which  he  began  by  assuming,  and 
makes  no  attempt  to  modify  his  method.  This  would  not 
be  the  behavior  of  the  true  skeptic,  of  course,  in  the  literal 
and  proper  sense  of  that  much  abused  word.  He  would 
"look  about,"  which  is  the  meaning  of  the  word.  The 
Middlesex  experiments — I  do  not  refer  to  the  earliest 
ones,  which  were  a  mere  burlesque — were  undertaken  as 
a  direct  consequence  of  my  articles  in  the  Pall  Mall 
Gazette  last  December,  and  I  should  have  been  delighted, 
of  course,  to  observe  them,  and  offer  any  help  I  could; 
but  neither  Dr.  Beard  nor  I  was  even  informed  of  their 
occurrence. 

In  concluding  a  chapter  which  I  repeatedly  describe 
as  provisional,  I  would  ask  for  what  must  be  of  the  great- 
est value — ^the  help  of  the  veterinary  surgeon.  Nothing 
has  yet  been  made  of  the  opportunities  furnished  by  can- 
cer in  the  lower  animals,  apart  from  the  mouse.  In  them 
it  is  perfectly  legitimate,  for  instance,  to  experiment  with 
the  treatment,  even  in  very  early  cases  which  the  surgeon 
could  remove  in  toto  with  practical  certainty.  It  is  by 
this  means,  I  believe,  that  we  shall  learn  in  a  very  short 
time,  and  without  risk  to  any  human  being,  what  could 


THE  DETAILS  OF  TREATMENT        177 

scarcely  be  learned  at  all  on  that  condition  from  human 
patients.     The  young  veterinary  surgeon  has  a  splendid 
opportunity  in  this  field  at  the  present  time.     He  can 
inform  us  as  to  the  practical  limits  of  dosage  of  the  fer- 
ments ;  the  length  of  time  during  which  one  dose  acts, 
judged  by  the  rate  of  excretion ;  the  proper  variations  of 
dosage,  vi^ith   (i)   the  type  of  the  tumor,  and   (2)   the 
factor  of  its  mere  mass ;  and  he  can  discover  for  us  the 
ideal  proportion  between  trypsin  and  amylopsin  in  any 
dose.     This  may  be  a  constant  proportion,  but  the  point 
seems  not  quite  certain  to  me.     The  amount  of  digestion 
that  may  be  effected  by  a  given  quantity  of  a  ferment  is 
not  finite — a  fact  we  are  apt  to  forget.     A  single  dose,  a 
single  molecule,  of  trypsin,  is  capable  of  digesting  an 
infinite  quantity  of  any  proteid  that  it  can  digest  at  all ; 
and  thus  a  single  dose  of  trypsin  might  conceivably  digest 
an  entire  tumor,  however  large,  if  it  digested  any  portion 
of  it,  provided  that  it  was  not  removed  from  the  tumor 
by  the  circulation  or  destroyed  by  the  cancer-ferment  or 
ferments.     Only  these  possibilities  necessitate  the  repeti- 
tion of  a  dose  itself  effective  at  all.     I  shall  be  deeply 
interested  to  learn  the  exact  facts  of  the  excretion  of  a 
dose  of  trypsin.     Von  Leyden,  Bergell,  Pinkus,  Pinkuss, 
and  others,  have  shown  that  the  ferment  can  be  recov- 
ered in  the  urine  in  an  active  state ;  but  can  it  all  be  re- 
covered (i)  in  health,  (2)  in  cases  of  cancer,  (3)  equally' 
in  cases  which  it  markedly  affects  and  those  which  it  does 
not  appear  to  affect  at  all?     Is  it  destroyed,  so  as  to  be 
irrecoverable,   in  these  cases,  assuming  them  to  exist? 
How  soon  does  it  appear  in  the  urine,  and  at  what  period 
does  it  disappear  from  the  urine?     These  are  only  a  few 
of  the  questions  which  will  occur  to  any  pharmacolog- 
ically-minded reader,  and  they  are  one  and  all  of  practical 


178     THE  CONQUEST  OF  CANCER 

moment.  I  believe  they  will  be  most  rapidly  answered  by 
the  veterinary  surgeons,  and  I  earnestly  commend  the 
inquiry  to  them.  Dr.  Beard  has  found  the  road,  and  it  is 
for  others  to  march  to  the  utter  conquest  of  cancer. 

In  the  next  chapter  I  discuss  the  important  work  of 
Dr.  Cleaves  in  this  relation.  Here  I  briefly  add  the  spec- 
ulation, elsewhere  referred  to,  that  the  beginning  with 
small  and  gradually  increased  doses  rather  suggests  the 
likeliest  fashion  in  which  to  immunise  the  tumor,  and 
also  the  observation  that  all  ferment  actions  are  reversi- 
ble in  certain  conditions,  and  that  this  fact  has  yet  to  be 
studied  in  the  present  connection. 

This  is  perhaps  as  convenient  a  place  as  any  in  which 
to  discuss  an  important  paper  by  Dr.  Monckton  Cope- 
man,  F.R.S.,  which  appeared  in  the  Practitioner,  August, 
1907.  As  a  preliminary,  one  remarkable  sentence  of  the 
author's  may  be  quoted.  He  says  that  the  new  treatment 
"has  apparently  been  proved  incapable,  alone,  of  prevent- 
ing the  inevitably  fatal  termination  of  the  disease."  This 
extraordinary  phrase,  "proved  incapable,"  beggars  my 
capacity  for  comment.  I  have  no  available  words  to  use 
when  a  distinguished  Fellow  of  the  Royal  Society,  who 
is  surely  acquainted  with  the  meaning  of  the  word  proof 
in  exact  thought,  and  with  the  nature  of  scientific  proof, 
can  declare  that  the  treatment  has  been  "proved  incapa- 
ble." What  would  Dr.  Copeman  and  every  one  else  say, 
I  wonder,  if  I  had  adduced  as  proof  for  the  treatment 
evidence  of  the  quality  which  he  regards  as  apparent 
proof  against  it?  Seemingly  it  is  necessary  to  observe 
once  more  that  a  negative  result — assumed  for  the  argu- 
ment to  be  validly  obtained — demonstrates  nothing  be- 
yond itself,  while  a  positive  result — similarly  assumed  to 
be  validly  obtained — proves  in  the  proper  sense.     Each 


THE  DETAILS  OF  TREATMENT        179 

alike  requires  confirmation.  But  there  is  no  comparison 
between  the  weight  of  the  two,  otherwise  the  bhnd  man 
is  entitled  to  assert  as  proved  that  the  sun  cannot  be  seen 
— he  cannot  see  it ;  the  fact  of  his  observation,  or  failure 
of  observation,  is  valid,  but  it  proves  nothing  against  the 
man  who  can  see.     These  are  the  very  elementa  of  logic. 

Dr.  Copeman  does,  however,  admit  some  results  from 
the  treatment,  including  relief  from  pain,  which  I  note, 
because  it  is  incapable  of  inclusion — though  he  does  not 
note  the  point — within  the  very  interesting  explanation 
which  he  furnishes.  Brushing  aside  the  old  methods  of 
approaching  the  problem  from  the  side  of  microscopic 
appearance,  Dr.  Copeman  makes  a  fresh  start  from  the 
chemical  standpoint,  and  this  it  is  which  makes  his  paper 
so  welcome.  He  returns  to  the  conception,  which  had 
been  thought  disproved,  that  cancer  is,  in  a  true  sense,  a 
constitutional  disease — in  other  words,  that  the  "general 
body  metabolism  is  primarily  at  fault."  The  evidence  of 
this  he  finds  in  the  observation  communicated  by  Prof. 
Benjamin  Moore  to  the  Royal  Society,  March  i6,  1905, 
and  noted  elsewhere,  that  in  cancer  generally,  and  not 
only  in  cancer  of  the  stomach,  the  secretion  of  hydro- 
chloric acid  by  the  glands  of  the  stomach  is  greatly  dimin- 
ished or  abolished,*  and  in  the  further  observation  that 
the  blood  is  usually  of  excessive-  alkalinity  in  cancer. 
This  fact  he  regards  as  the  first  of  a  series  dependent 
upon  it,  though  the  question  of  its  causation  is  not  con- 
sidered. The  blood  being  more  alkaline — or  being  de- 
ficient in  hydrogenions,  to  use  the  modern  phraseology — 
the  gastric  glands  are  unable  to  produce  hydrochloric 
acid.     Now,  in  the  absence  of  this  acid  from  the  fluid  or 

*But,  puzzlingly  enough,  Dr.  Copeman  finds  the  gastric  HCl 
increased  in  "cancer-mice." 


180     THE  CONQUEST  OF  CANCER 

semi-fluid  material  that  passes  from  the  stomach  into  the 
bowel,  there  is  not  produced  by  the  bowel  the  secretin 
of  Prof.  Starling,  which  is  normally  called  forth  by  the 
acid  stimulus,  and  which,  after  absorption,  reaches  the 
pancreas  and  causes  it  to  pour  forth  its  trypsinogen, 
which,  on  reaching  the  bowel,  is  fermented  by  entero- 
kinase,  with  the  formation  of  trypsin.  Thus  the  cancer- 
patient  lacks  his  pancreatic  secretion — not  because  his 
pancreas  is  disordered,  but  because,  in  the  first  place, 
his  blood  is  too  alkaline.  Dr.  Copeman  suggests  that  the 
nutritional  disturbance  of  the  disease  is  due,  in  part,  at 
any  rate,  to  this  defect  of  the  pancreatic  secretion ;  and 
thus  he  seeks  to  explain  the  beneficial  results  which,  as  he 
admits,  do  in  some  cases  follow  the  pancreatic  treatment. 
As  I  have  noted,  however,  this  explanation  does  not  cover 
the  relief  of  pain  which  Dr.  Copeman  himself  admits; 
and  I  am  very  sure  that  if  Dr.  Copeman  had  himself 
made  observation  of  this  treatment — an  opportunity 
which  our  critics,  almost  without  exception,  have  rigor- 
ously denied  themselves — he  would  realize  that  an  ex- 
planation which  does  not  cover  the  amazing,  immediate, 
consistent  and  continuous  relief  of  pain  in  these  cases, 
is  very  far  from  adequate.  Dr.  Copeman,  however,  does 
not  admit  or  consider  the  possibility  that  the  pancreatic 
secretion  has  any  specific  action  upon  cancer,  and  he 
makes  no  allusion  whatever  to  the  authoritative  German 
work  which  has  exhaustively  proved  the  existence  of  this 
specific  action.  It  is  a  great  pity  that  really  responsible 
and  distinguished  students  should  deliver  themselves  of 
opinions  on  the  treatment  without  having  observed  it  for 
themselves.  If  I  had  had  nothing  but  hearsay  to  base 
my  crusade  upon,  I  should  have  been  rightly  condemned 


THE  DETAILS  OF  TREATMENT        181 

by  every  one;  but  the  opponent  who  has  nothing  but 
hearsay  to  go  upon  is  not  criticized  on  that  ground  by 
any  one.  For  the  advocates  of  the  treatment,  the  most 
rigorous  critical  criteria ;  for  its  opponents,  none  what- 
ever— not  even  the  expectation  that  they  shall  publish 
their  experiments !  I  must  return,  however,  from  what 
is  surely  a  warrantable  digression. 

Dr.  Copeman  admits,  then,  that  the  pancreatic  treat- 
ment may  be  of  some  value,  but  his  explanation  is  not  that 
trypsin  is  thereby  introduced  into  the  blood — for  he  ap- 
parently does  not  contemplate  at  all  the  possibility  that 
the  trypsin  formed  in  the  bowel  from  the  pancreatic  secre- 
tion may  normally  enter  the  blood — but  that  the  treat- 
ment stimulates  the  pancreas  to  pour  forth  its  secretion 
into  the  bowel,  and  possibly  also  to  pass  into  the  blood 
some  ''internal  secretion."  Evidently  Dr.  Copeman  is 
not  so  far  from  what  I  believe  to  be  the  right  conception, 
if  he  can  suggest  that  the  pancreatic  treatment  may  be 
of  value  in  causing  the  patient's  pancreas  to  pour  forth 
some  internal  secretion  into  the  blood,  even  though  he 
presumably  supposes  this  to  affect  the  general  nutrition 
only. 

It  might  have  been  expected  that  Dr.  Copeman  would 
now  proceed  to  recommend  the  adoption  of  the  pan- 
creatic treatment  as  a  palliative  agent  in  dealing  with 
cancer.  But,  curiously  enough,  he  proposes  to  effect  the 
end  which  the  pancreatic  treatment  directly  attains  by 
the  very  indirect  method  of  adnuiiistcring  acids,  in  order 
that  the  alkalinity  of  the  blood  may  be  lessened,  the  secre- 
tion of  gastric  acid  increased,  secretin  formed,  and  the 
pancreas,  finally,  stimulated.  He  tells  us  that,  at  the 
time  of  writing,  he  is  making  trial  of  Prof.  Aletchnikoff's 


18a     THE  CONQUEST  OF  CANCER 

lactic  acid  milk  for  this  purpose.     It  will  be  interesting 
to  hear  what  results  he  obtains.* 

Meanwhile,  however,  it  is  necessary  to  look  further  at 
Dr.  Copeman's  argument.  "Cancer  constitutes,"  he  says, 
"the  local  manifestation  of  perverted  body  metabolism" 
— the  evidence  of  this  being  the  defective  secretion  of 
hydrochloric  acid,  dependent  upon  the  increased  alkalinity 
of  the  blood.  Without  present  reference  to  the  question 
whether,  at  least,  some  local  factor  is  also  necessary — 
cancer  being,  as  I  now  believe,  neither  a  constitutional 
disease  only,  nor  a  local  disease  only,  but  necessarily  both 
— let  us  address  ourselves  to  this  question  of  the  increased 
alkalinity  of  the  blood,  the  causation  of  which  Dr.  Cope- 
man  does  not  consider.  We  have  to  remember  that,  in 
this  continuous  universe,  to  find  a  cause  is  only  to  raise 
a  fresh  question  as  to  the  cause  of  that  cause.  Now,  if 
increased  alkalinity  of  the  blood  be  the  fact  of  "perverted 
body  metabolism"  of  which  "cancer  constitutes  the  local 
manifestation,"  and  if  the  arrest  of  pancreatic  action  be 
the  consequence  of  that  change,  surely  it  is  suggested 
that  this  arrest  of  pancreatic  action  is  the  factor  that 
permits  or  determines  the  "local  manifestation."  In  a 
word,  surely  Dr.  Copeman's  own  reasoning  leads  to  the 
conclusion  that  the  pancreatic  secretion,  internal  or  ex- 
ternal, can  prevent  the  growth  of  cancer.  Again  it  ap- 
pears to  me  that  Dr.  Copeman's  own  words  and  argu- 
ments do,  in  effect,  entitle  us  to  claim  him  as  almost  the 
first  distinguished  convert  in  this  country  to  Dr.  Beard's 
theory  that  trypsin  must  control  cancer — even  though,  in- 

^Citric,  acetic  and  other  organic  acids  are  oxidized  in  the  blood 
with  the  formation  of  carbonates  and  increased  alkalinity.  I 
suspect  that  this  may  happen  with  lactic  acid.  Also  Jactic  acid  de- 
stroys trypsin,  even  in  greater  dilution  than  hydrochloric  acid! 


THE  DETAILS  OF  TREATMENT        183 

stead  of  giving  the  pancreatic  secretion  directly,  he  pre- 
fers to  evoke  it  by  giving  lactic  acid  bacilli — a  therapeutic 
method  perhaps  the  most  indirect  ever  suggested,  in- 
volving as  it  does  the  (dubious)  interposition  of  some 
half-dozen  delicate  bio-chemical  processes.  It  may  be 
noted,  also,  that  it  is  scarcely  necessary  to  attribute  to 
pancreatic  injections — still  less  to  lactic  acid  milk — as 
against  pancreatic  injections,  any  virtue  as  regards  stim- 
ulating the  pancreas  to  produce  its  internal  secretion, 
since  this  internal  secretion  must  in  any  case  be  present 
in  the  injections,  made  as  they  are  from  the  fresh  pan- 
creas-gland. The  more  Dr.  Copeman's  arguments  are 
examined,  the  more  support  they  render  our  case,  though 
he  makes  no  mention  of  Dr.  Beard  or  his  teaching,  and 
includes  the  usual  gibe  at  the  treatment  as  being  much 
vaunted  in  the  lay  press.  Were  it  not  for  this  said  lay 
press,  we  should  still  be  as  we  were  at  the  end  of  the  year 
1905,  so  far  as  cancer  is  concerned,  and  many  persons 
now  above  ground  would  be  beneath  it. 

Now  it  is  necessary  to  inquire  into  possible  variations 
in  the  alkalinity  of  the  blood  at  different  ages,  and  into 
the  possibility  that  this  alkalinity  is  excessive  prior  to 
the  development  of  cancer.  The  facts,  I  submit,  entirely 
negative  Dr.  Copeman's  theory.  If  the  excessive  alka- 
linity of  the  blood  were  primary,  or  proximately  primary, 
as  he  suggests,  defective  secretion  of  hydrochloric  acid, 
and,  in  consequence,  marked  and  unmistakable  dyspepsia, 
should  be  the  constant  or  common  precursor  of  malignant 
disease.  This  is  certainly  not  so,  and  the  fact  is  conclu- 
sive in  my  opinion  against  Dr.  Copeman's  hypothesis. 

On  the  contrary,  I  believe  that  the  increased  alkalinity 
of  the  blood  in  malignant  disease  follozvs  upon,  and  is  not 
a  cause  of,  its  development.     I  believe  further,  as  against 


184«  THE  CONQUEST  OF  CANCER 

Dr.  Copeman,  that  this  increased  alkalinity,  so  far  from 
being  a  sign  of  perverted  body  metabolism,  of  which  the 
disease  is  the  local  manifestation,  is  a  compensatory  and 
protective  mechanism  on  the  part  of  the  body.  Trypsin 
acts  best  in  an  alkaline  medium,  as  is  generally  known; 
the  cancer-ferments  act  in  an  acid  medium,  and  the  di- 
gestive processes  by  which  a  cancer  lives  are  acid.  I 
need  not  here  revert  to  this  question.  But  the  therapeutic 
indication,  I  believe,  so  far  from  being  the  administration 
of  acids,  is  the  administration  of  alkalies,  which  will  tend 
to  favor  the  activity  of  trypsin  and  to  disfavor  the  activity 
of  the  cancer  or  trophoblastic  ferment  or  ferments.  I 
recommended  the  use  of  alkalies  as  an  aid  to  trypsin  in 
one  of  my  early  articles  "in  the  lay  press" — the  only  press 
open  to  me  or  to  Dr.  Beard  in  Great  Britain  since  Janu- 
ary, 1906 — and  I  am  now  more  strongly  of  opinion  than 
ever  that  this  measure  is  to  be  recommended  as  a  rational 
addition  to  the  treatment  in  some,  if  not  all,  cases. 

Meanwhile  it  is  desirable  that  the  alkalinity  of  the 
blood  be  examined  in  cases  of  spontaneous  cure,  and  I 
will  venture  to  predict  that  in  these  cases — which  offer 
priceless  and  hitherto  wholly  neglected  opportunities  for 
the  study  of  the  disease  on  chemical  (i.e.  the  only  profit- 
able) lines — the  alkalinity  of  the  blood  will  be  found  even 
higher,  if  anything,  than  in  cases  which  are  running  the 
usual  course. 

It  may  be  noted  that  observations  subsequent  to  those 
of  Prof.  Moore  seem  to  show  that  the  diminution  or 
absence  of  gastric  hydrochloric  acid  in  cases  of  cancer 
is  highly  variable  and  inconstant.  These  variations  may 
be  of  great  importance,  and  may  be  found  to  correspond 
with  variations  in  the  progress  of  the  disease  in  the  fash- 
ion already  indicated. 


CHAPTER  XIV 

THE  GENERAL  ACTION   OF   THE  FERMENTS 

Perhaps  there  is  no  other  indication  of  the  hopeless- 
ness with  which  the  treatment  of  cancer  was  regarded, 
and  the  dominance  of  the  idea  that  this  is  "a.  surgical 
disease,"  than  the  fact  that,  notwithstanding  the  promi- 
nence lately  accorded  to  what  is  called  organo-therapeu- 
tics,  or  opo-therapy,  and  the  magnificent  success  won  by 
it  in  certain  quarters,  it  actually  occurred  to  no  one,  so 
far  as  I  know,  to  essay  the  treatment  of  cancer  by  such 
means.  The  success  of  the  thyroid-gland  as  a  true,  spe- 
cific cure  for  cretinism  and  myxoedema,  as  the  latest  great 
achievement  of  medicine,  and  the  maxim  of  the  curative 
power  of  nature  as  perhaps  its  most  ancient  doctrine, 
together  with  the  fact  of  occasional  spontaneous  cure,  so 
vastly  significant  and  so  wholly  neglected  even  by  the 
merest  speculators — these  might  surely  have  led  to  the 
employment  of  some  form  of  organo-therapeutics  in  can- 
cer long  ago,  or  at  least  in  the  closing  years  of  the  nine- 
teenth century.  This,  however,  as  a  passing  reflection, 
sufficient  to  show  how  repeated  failure  had  checked  fer- 
tility of  suggestion,  and  how  entirely  the  surgeon,  prac- 
ticing in  modern  guise  the  oldest  and  rudest  of  all  healing 
measures,  dominated  the  situation. 

Now,  though  the  pancreatic  ferments  are  normal  in- 
habitants of  the  body,  and,  therefore,  not  drugs  in  the 
ordinary  sense  of  the  word,  but  rather  special  foods,  it 
'       185 


186     THE  CONQUEST  OF  CANCER 

is  necessary  to  study  their  consequences  when  adminis- 
tered in  health,  which  belong  to  pharmacology,  and  when 
administered  in  malignant  disease,  these  last  belonging 
to  clinical  therapeutics.  This  whole  subject  is  still  m 
its  infancy,  but  certain  myths  have  already  been  dissi- 
pated, and  facts  observed,  especially  by  Dr.  Margaret 
Cleaves,  in  New  York,  and  by  Drs.  Pinkuss  and  Pinkus 
in  Berlin.  Detailed  reference  is  made  elsewhere  to  the 
results  of  these  latter  workers,  and  here  I  will  refer  espe- 
cially to  the  careful  and  laborious  and  prolonged  observa- 
tions of  Dr.  Cleaves. 

As  a  preamble,  we  may  mention,  merely  in  order  to 
dismiss  it,  the  notion,  elsewhere  referred  to,  that  trypsin 
entering  the  blood  would  digest  the  body.  That,  of  course, 
is  as  untrue  as  any  belief  can  be. 

But  apart  from  this,  our  beliefs  as  to  the  pharmacology 
of  trypsin,  hitherto,  were  simply  that,  administered  by 
the  mouth,  it  might  facilitate  the  process  of  digestion, 
assuming  that  it  escaped  destruction  by  the  hydrochloric 
acid  of  the  stomach;  and  secondly,  that,  injected  into  the 
blood,  it  aroused  the  formation  of  an  opposing  substance 
to  which  the  name  of  anti-trypsin  was  given.  This  last 
belief  has  been  disproved  by  the  German  workers,  who 
have,  however,  found  an  anti-body  when  extracts  of  de- 
composing pancreas  are  used. 

But  what  will  be  the  action  upon  the  normal  body  of 
large  doses  of  active  trypsin  injected  into  the  blood?  Un- 
til the  rise  of  the  new  treatment  it  should  have  occurred 
to  no  one  to  expect  poisonous  symptoms,  for  it  should 
have  occurred  to  no  one  to  regard  this  normal  constituent 
of  the  body  as  a  poison :  we  have  seen,  however,  the  old 
delusion  as  to  its  digesting  the  body.  But  the  demonstra- 
tion of  its  poisonous  action  upon  cancer,  and  the  excite- 


GENERAL  ACTION  OF  FERMENTS      187 

ment  of  toxic  symptoms  by  its  use  in  cancer,  led  to  the 
confirmation  of  the  opinion  in  many  quarters  that  the 
ferment  is  essentially  a  poison,  to  be  regarded  as  such, 
used  with  the  utmost  caution,  and  especially  with  scrupu- 
lous reference,  as  in  the  case  of  other  poisons,  to  an  upper 
limit  of  safety  in  its  dosage.  Now,  before  we  accept  or 
dismiss  this  conception,  it  is  absolutely  necessary  to  study 
the  pure  pharmacology  of  the  drug — its  action  upon  the 
healthy  body.  It  was  the  non-existence  of  pharmacology, 
and  the  observance  of  effects  produced  in  disease  alone, 
that  for  ages  prevented  the  evolution  of  a  scientific  thera- 
peutics. If  we  do  not  know  the  action  of  a  drug  in  health 
we  cannot  really  know  its  action  in  disease. 

Reference  has  elsewhere  been  made  to  the  first  experi- 
ments of  Pinkus,  who  showed  that  relatively  gigantic 
doses  of  trypsin,  injected  under  the  skin  of  a  healthy  dog, 
produced  absolutely  no  symptoms  or  results  whatever, 
except  an  increase  in  weight,  which  might  well  be  at- 
tributed to  the  facilitation  of  the  animal's  digestion.  These 
experiments  were  of  much  importance,  for  the  simple 
reason  that  nothing  as  to  the  action  of  trypsin  in  the 
blood  can  be  properly  inferred  from  the  administration 
of  the  drug  by  the  mouth,  which,  unless  exceptional  pre- 
cautions are  taken,  must  involve  its  almost  immediate 
destruction  by  the  healthy  stomach.  The  experiments  of 
Pinkus  were  also  important  as  proving  that  trypsin  can 
circulate  in  the  blood  as  such,  and  be  removed  from  it  by 
the  kidneys,  without  suffering  change. 

A  whole  series  of  important  questions  are  thus  raised, 
and  definite  inquiry  must  be  directed  to  their  solution. 
Pinkuss  and  Pinkus  have  proved  for  animals  in  health, 
and  they  and  Von  Leyden  for  cancerous  human  patients, 
that  trypsin  may  circulate  in  the  blood  and  be  excreted 


188  THE  CONQUEST  OF  CANCER' 

by  the  kidneys.  Von  Leyden  gave  the  trypsin  by  the 
mouth,  and  it  must  have  been  absorbed  from  the  bowel. 
But  if  trypsin,  given  by  the  mouth,  can  be  absorbed  from 
the  bowel  of  cancerous  patients,  trypsin  formed  in  the 
bowel  can  be  similarly  absorbed  by  healthy  or  non-cancer- 
ous persons.  Bier  has  proved  the  existence  of  a  prote- 
olytic ferment  (or  ferments)  in  the  blood  of  the  normal 
lamb  and  pig — especially  the  latter,  the  pancreas  of  which 
is  highly  active.  It  is,  therefore,  urgently  necessary  to 
inquire  into  the  presence  of  trypsin  in  normal  blood,  and, 
if  it  can  be  identified  there,  its  variations  at  different  ages 
and  in  cancerous  patients  to  whom  trypsin  is  not  being 
administered.  But  the  knowledge  already  in  our  pos- 
session shows  that  the  kidneys,  by  means  of  their  secre- 
tion, furnish  an  index  on  this  point.  It  is  necessary,  then, 
that  the  urine  be  examined  for  trypsin,  not  merely  in  ani- 
mals or  human  beings,  healthy  or  cancerous,  to  whom 
tr\-psin  has  been  administered,  but  in  animals  and  human 
beings,  both  in  health  and  in  cases  of  malignant  disease, 
to  whom  trypsin  has  not  been  administered.  Many  ques- 
tions readily  suggest  themselves.  Is  trypsin  normally  to 
be  found  in  the  urine — i.e.,  normally  present  in  the  blood 
— of  healthy  persons?  Does  it  tend  to  diminish  at  the 
ages  specially  liable  to  the  incidence  of  cancer?  Is  it 
diminished  in,  or  absent  from,  the  urine  of  cancerous 
patients?  It  seems  to  me  that  the  answer  to  these  ques- 
tions may  prove  to  be  of  enormous  importance,  and  they 
should  be  easily  and  quickly  answered  by  modern  methods 
of  investigation.  Here  we  may  be  on  the  verge  of  the 
elucidation  of  the  conditions  w^hich  permit  the  growth  of 
cancer  in  one  patient  and  not  in  another;  at  one  age  and 
not  at  another;  and  it  may  appear  that  the  absence  of 
trypsin   (or  some  other  cancrotoxic  ferment)    from  the 


GENERAL  ACTION  OF  FERMENTS      189 

urine — in  which,  as  we  can  scarcely  doubt,  after  studying 
the  work  of  Bier,  it  should  be  normally  present — may  con- 
stitute a  warning  of  the  imminence  of  cancer,  and  an 
obvious  prophylactic  indication. 

An  important  point  must  be  made  here.  Though  I  most 
heartily  welcomed,  and  have  ever  since  given  prominence 
to,  the  demonstration  of  the  excretion  of  trypsin  by  the 
kidneys,  after  either  hypodermic  (Pinkus)  or  oral  (Von 
Leyden)  administration,  since  it  suffices  to  prove  that 
these  methods  will  insure  its  reaching  a  malignant  growth, 
injection  into  the  growth  (and  all  secondary  growths) 
being  thus  unnecessary — yet,  apart  from  its  proof  of  this 
possibility,  the  fact  is  much  to  be  regretted.  Evidently, 
it  would  be  much  more  desirable  that  the  precious  remedy 
be  not  so  removed,  but  permitted  to  circulate  in  the  blood 
for  prolonged  periods.  Far  more  satisfactory  would  it 
be  if,  like  many  drugs,  trypsin  had  a  "cumulative"  action, 
the  proportion  of  it  in  the  blood  gradually  mounting  as 
the  treatment  continued.  If  this  were  so,  obviously  the 
whole  character  and  duration  of  the  treatment  in  prac- 
tice would  be  modified.  Much  work  will  have  to  be  done 
in  this  field.  At  present  we  have  the  work  of  the  German 
observers  alone  to  guide  us.  I  am  anxious  to  know,  for 
instance,  why  Drs.  Finkuss  and  Pinkus  should  find  tryp- 
sin in  the  urine,  in  certain  cases,  so  late  as  after  the  forty- 
eighth  injection,  for  the  first  time.  Was  this  an  indication 
of  saturation  of  the  blood  by  the  ferment?  Many  allied 
questions  might  be  asked,  and  will,  ere  long,  be  answered. 

Systematic  experiment  is  still  lacking  as  to  the  effect 
of  the  administration  of  trypsin  by  the  skin  in  healthy 
human  beings.  There  is  every  reason  to  suppose  that  the 
results  would  be  similar  to  those  obtained  in  the  dog. 
Trypsin  is  not  a  poison  to  normal  tissues,  and  can  have 


190     THE  CONQUEST  OF  CANCER 

no  poisonous  action  upon  a  body  which  contains  only 
somatic  tissue — that  is  to  say,  tissue  proper  to  the  body 
itself.  According  to  the  theory  of  Dr.  Beard,  trypsin  is 
"the  architect  of  the  soma" — that  is  to  say,  of  the  body. 
It  is  by  tryptic  digestion  of  food  material  that  that  food- 
material  is  built  up  into  the  body,  and  it  is  inconceivable, 
therefore,  that  trypsin  can  have  any  action  during  life 
upon  the  soma  or  sexual  individual,  "while  its  action  is 
direct  and  utterly  ruinous  upon  trophoblast  or  asexual 
generation." 

At  this  point  some  precise  experimental  help  is  afforded 
us  in  a  very  valuable  and  original  paper  by  Dr.  Margaret 
Cleaves.^ 

In  this  paper.  Dr.  Cleaves  quotes  an  illustrative  case 
where  a  patient  was  treated  by  her  with  the  pancreatic 
ferments,  on  the  mistaken  diagnosis  by  the  microscope, 
that  the  patient  was  suffering  from  cancer.  She  says  that 
the  results  obtained  were  similar  to  those  obtained  by  Dr. 
Pinkus  in  his  experiments  upon  healthy  dogs.  I  quote : 
"This  patient  was  given  injections  of  trypsin  of  special 
strength  daily  for  four  weeks ;  in  the  first  week,  from 
one-third  to  one-half  ampoule,  and  afterward  from  one 
to  two  ampoules,  without  any  amylopsin,  without  any 
reaction,  and  with  steady  nutritive  gain.  This  was  evi- 
denced by  the  urine  analysis  as  well  as  by  the  patient's 
appearance  and  condition  of  improved  metabolism,  and 
her  gain  in  weight  from  December  2,  1906,  to  February 
15,  1907,  of  twenty  pounds.  She  never  had  a  rise  of 
temperature,  nor  any  save  local  reaction  from  the  punc- 
tures."    This  case  supports  Dr.   Cleaves's  opinion  that 

^"The  Physiological  Action  of  the  Pancreatic  Enzymes^  with 
special  reference  to  Hematology,  Urinology,  and  Clinical  Pathol- 
ogy."   N.  Y.  Medical  Record,  June  i,  1907. 


GENERAL  ACTION  OF  FERMENTS      191 

"in  non-malignant  conditions,  large  and  long-continued 
doses  are  well  borne^  as  there  is  no  reaction  other  than 
the  local  one  at  the  site  of  the  injection." 

This  proposition  is  of  immense  importance,  not  merely 
because  it  affords  a  correct  conception  of  trypsin,  teach- 
ing us  that,  if  it  be  a  poison  at  all,  it  is  only  a  poison  to 
cancer  and  normal  trophoblast,  but  more  especially  be- 
cause it  teaches  us  to  interpret  correctly  such  toxic  symp- 
toms as  may  arise  in  the  course  of  treating  patients.  We 
have  to  learn,  first  of  all,  that  these  are  not  symptoms  of 
poisoning  by  trypsin,  there  being  none  such ;  but  rather 
the  occurrence  of  these  symptoms,  in  the  first  place,  con- 
stitutes a  confirmation  of  the  diagnosis  of  malignant  dis- 
ease, and,  in  the  second  place,  depends  upon,  and  there- 
fore demonstrates,  an  action  of  the  ferment  upon  the 
malignant  tissue.  Thus  in  cases  where  no  toxic  symp- 
toms are  observed,  not  even  to  the  extent  of  an  occasional 
rise  in  temperature  of  one  or  two  degrees,  the  strong 
presumption  is — assuming  malignant  disease  to  be  present 
— that  inert,  or  practically  inert,  injections  are  being  em- 
ployed. I  speak  now  of  the  use  of  trypsin  together  with 
the  small  quantity  of  amylopsin  that  accompanies  it,  as 
the  use  of  sufficient  amylopsin  controls  these  toxic  symp- 
toms. 

But  we  must  now  pass  to  consider  the  question  which 
is  evidently  raised  by  the  foregoing.  Clearly  understand- 
ing that  the  pharmacological  action  of  trypsin  is  nil,  we 
must  inquire  into  the  general  results  of  its  administration 
when  there  is  present  the  malignant  or  trophoblastic  tis- 
sue upon  which  alone  it  can  act.  This  is  a  matter  of  the 
utmost  importance  on  account  of  its  relation  to  the  ques- 
tion of  dosage.  We  rnay  begin  by  discussing  the  local 
reaction. 


192     THE  CONQUEST  OF  CANCER 

This  local  reaction,  which  has  not  infrequently  been 
a  real  obstacle  to  treatment,  has  nothing  whatever  to  do 
with  trypsin  as  such,  any  more  than  had  the  abscesses 
which  were  produced  by  the  first  American  reporter  on 
this  subject,  and,  on  at  least  one  occasion,  by  the  Middle- 
sex Hospital  experimenters.  Local  symptoms  have  de- 
pended upon  the  introduction  of  living  micro-organisms, 
upon  the  presence  of  acetic  acid  in  the  injections,  or  of 
glycerine  or  other  irritant  substances  used  for  purposes 
of  extraction  or  preservation  of  the  ferment.  Dr.  Luther 
reported,  as  long  ago  as  February,  1907,  that  he  had  made 
five  hundred  injections  without  an  abscess ;  and  Dr.  Meg- 
gitt,  in  the  first  report  of  real  value  that  appeared  in 
Great  Britain  {General  Practitioner,  August  31,  1907), 
observed  that  he  had  made  nearly  one  thousand  injec- 
tions without  any  such  result.  The  latest  and  best  injec- 
tions, of  which  I  have  been  watching  the  results  for  nearly 
a  year,  cause  scarcely  any  local  reaction  whatever.  The 
previous  experience,  however,  has  been  that  there  is  a 
marked  difference  between  the  injections  of  trypsin  and 
amylopsin,  in  this  respect,  and  the  suggestion  has  natu- 
rally been  that  this  is  due  to  a  special  action  of  the  trypsin. 
The  manufacturing  chemists  do  not  inform  us  as  to  the 
details  of  their  various  methods,  but  there  is  no  question 
that  some  irritant  agent  or  agents  are,  in  most  cases, 
employed  in  making  the  trypsin  injections,  which  are 
absent  from  those  of  the  amylolytic  ferment. 

Of  far  greater  moment  is  the  general  reaction  to  the 
use  of  these  ferments  in  patients  suffering  from  malig- 
nant disease.  Dr.  Cleaves  has  had  very  careful  examina- 
tions made  of  the  blood  in  her  cases,  and  in  all  except 
the  patient  whose  case  was  wrongly  diagnosed  as  malig- 
nant, and  in  whom  she  was  led  by  the  absence  of  the 


GENERAL  ACTION  OF  FERMENTS      193 

reaction  to  have  the  microscopic  verdict  corrected,  she 
has  observed  a  characteristic  change  in  the  blood  which 
leads  her  to  speak  of  the  trypto-glycogenic  reaction  in 
these  cases.  It  is  earnestly  to  be  hoped  that  her  observa- 
tions may  soon  be  confirmed.  She  finds,  in  all  her  (ma- 
lignant) cases  treated  by  the  pancreatic  ferments,  a  "dis- 
tinct and  very  characteristic"  increase  in  the  proportion 
of  so-called  eosinophile  leucocytes,  or  white  cells  in  the 
blood.  These  particular  leucocytes  are  so  named  since, 
on  staining  with  eosin,  a  red  dye,  they  display  large  num- 
bers of  red-stained  granules.  The  percentage  of  these 
cells,  she  finds,  rises  rapidly,  under  the  treatment,  from 
I  to  3  per  cent,  to  as  high  as  25  to  27  per  cent,  of  all  the 
white  cells.  Now,  there  is  evidence  which  suggests  (see 
Habershon,  Journal  of  Pathology  and  Bacteriology,  De- 
cember, 1906)  that  the  eosinophile  granules  consist  of  the 
carbohydrate  body  glycogen,  or  animal  starch.  Eosino- 
philia,  as  this  condition  of  the  blood  is  called,  is  com- 
monly observed  in  various  diseases  in  which  glycogen  is 
present  in  abnormal  quantities.  Now,  malignant  tumors 
are  commonly  very  rich  in  glycogen — "fully  80  per  cent, 
of  tumors  in  their  final  stages  are  associated  with  glyco- 
gen in  pathological  quantities,"  and,  according  to  Lu- 
barsch,  "glycogen  is  constant  in  horny  degeneration  of  a 
squamous  cancer." 

In  the  light  of  these  facts,  Dr.  Cleaves  suggests  that 
"the  eosinophile  reaction  of  trypsin  is  due  to  a  degenera- 
tion of  cancerous  growth,"  trypsin  being  the  ferment  or 
catalytic  agent  which  splits  ofif  glycogen  from  what  Von 
Leyden  and  Bergell  call  the  "native  albumin"  of  cancer. 
Hence  Dr.  Cleaves  says : — 

"From  these  observations,  a  hypothesis  may  be  formu- 
lated, namely,  that  trypsin  acts  on  intra-cellular  matter  of 


194     THE  CONQUEST  OF  CANCER 

a  definite  configuration,  following  the  selective  law  of 
enzymes,  and  that  the  result  is  a  pathological  quantity 
of  glycogen  throughout  the  body,  manifested  especially  in 
the  eosin  granules,  and,  to  a  certain  extent,  probably 
stored  up  in  the  muscles.  As  glycogen  is  not  stored  up 
in  dead  cells,  but  rather  split  off  from  them,  and  as  it 
is  associated  in  nearly  all  cases  with  accumulations  in  the 
leucocytes  and  muscle-cells,  it  would  seem  fair  to  imagine 
that  in  cases  of  trypsin  reaction  the  body  is  saturated  with 
glycogen." 

Dr.  Cleaves  considers  that  an  important  factor  in  de- 
termining the  dosage  of  trypsin  is  "the  condition  of  the 
kidneys  before  and  after  treatment  is  instituted."  I  quote 
her  opinion  on  this  point : — 

"Trypsin  and  amylopsin  are  excreted  mainly  by  the 
kidneys,  producing  a  nephritis  more  or  less  extensive. 
Granular  casts  appear  in  the  urine  almost  immediately 
after  the  first  doses  of  the  ferments.  The  nephritis  does 
not  seem  to  be  progressive,  the  casts  and  albumin  remain- 
ing pretty  constant  unless  the  dosage  is  increased.  .  .  . 
In  every  instance,  casts  have  appeared  in  the  following 
order  :  ( i )  Occasional  fine  granular,  then  coarsely  granu- 
lar, (2)  hyaline,  (3)  epithelial.  Under  the  regimen  which 
forms  a  part  of  the  supplementary  treatment  and  h3'giene 
of  these  cases,  this  nephritis  is  kept  pretty  well  under 
control." 

It  has  to  be  remembered  that  even  the  best  injections 
must  be  of  highly  complex  composition.  I  am  at  present 
far  from  convinced  that  this  nephritis,  even  though  it  be 
not  of  a  serious  character,  is,  or  will  always  be,  a  neces- 
sary accompaniment  of  the  treatment. 


CHAPTER  XV 

THE  GERMAN   WORK 

The  reader  will  readily  understand  that  in  my  attempt 
to  gain  a  fair  hearing  through  all  kinds  of  noise  for  what 
I  believe  to  be  the  first  achievement  ever  made  in  the 
rational  treatment  of  cancer,  I  long  desired  the  support 
of  some  great  and  universally  recognized  authority,  speak- 
ing from  some  official  position  that  should  lend  weight 
to  his  words.  I  know  that  there  is  no  authority  but 
truth,  and  that  not  the  word  of  an  angel  from  heaven 
can  make  black  white.  That  combination  of  prejudice 
and  ignorance  which  has  played  such  a  part  in  human 
history  prevented  our  opponents  from  listening  even  to 
facts :  neither  would  they  be  persuaded  though  many 
rose,  if  not  from  the  dead,  at  any  rate  from  what  prom- 
ised to  be  their  death-bed.  But  critics  of  that  type  are 
just  the  very  persons  who  will  blindly  follow  authority, 
and  thus  a  new  stage  in  this  matter  was  reached  when 
it  was  taken  up  by  the  great  man  of  science  whose  con- 
tributions to  it  I  am  about  to  discuss.  Prof.  Ernst  Von. 
Leyden  was,  until  a  few  months  ago,  the  Professor  of 
Clinical  Medicine  in  the  University  of  Berlin,  and  his 
name  is  familiar  all  the  world  over  to  students  of  the 
medical  sciences.  He  is  also  the  head  of  the  Official 
Cancer  Research  of  the  German  Empire,  and  as  such  is 
certainly  the  foremost  official  authority  upon  malignant 
disease  in  the  whole  world.     Had  I  had  the  power,  I 

I9S 


196     THE  CONQUEST  OF  CANCER 

should  naturally  have  chosen  him,  of  all  men,  to  lend  the 
weight  of  his  name  and  reputation  and  position  to  the 
unbiased  and  thorough  study  of  Dr.  Beard's  pancreatic 
treatment  of  cancer.  Prof.  Von  Leyden  has  at  his  dis- 
posal the  unrivaled  resources  of  the  great  Institute  for 
the  study  of  cancer  which  he  controls — resources  not 
only  in  money  and  apparatus,  but  in  the  form  of  a  staff 
of  highly-skilled  experts.  Various  aspects  of  the  ques- 
tion are  now  being  worked  at  by  him  and  his  followers, 
and  I  have  little  doubt  that,  not  long  after  these  words 
appear  in  print,  the  practical  application  of  Dr.  Beard's 
discoveries  in  Germany  will  afford  an  object-lesson  to  the 
whole  world.  It  is  so  now  with  the  case  of  the  English 
'pioneer  whom  we  name  Jenner,  the  English  pioneer  whom 
we  name  Lister,  and  the  French  pioneer  whom  we  name 
Pasteur. 

More  than  two  years  ago,  Prof.  Blumenthal,  Von  Ley- 
den's  chief  assistant,  demonstrated  that  "all  carcinomata 
(cancers)  are  always  very  easily  digested  by  pancreatin 
(extract  of  pancreas),  whilst  on  the  contrary,  all  other 
tissues  of  the  organism  are  fairly  resistant  to  its  action." 
This,  of  course,  refers  to  test-tube  experiments  upon  dead 
tissues.  Pepsin,  on  the  contrary,  had  a  very  slow  and 
imperfect  action  upon  carcinoma  in  the  test-tube.  Later, 
Prof.  Bergell,  another  distinguished  physiological  chem- 
ist of  the  German  Cancer  Research,  proved  that  the  na- 
tive and  characteristic  albumin  of  cancer  is  easily  digested 
by  trypsin,  but  with  difficulty  by  pepsin. 

It  was  not  until  January,   1907,  however,  that  Prof. 

Von  Leyden  gave  us  an  indication  of  what  we  were  to 

expect  from  him  in  the  clinical  direction,  by  a  report  in 

the  Zentralhlatt  fur  die  gesdmte  Therap.  for  that  month. 

.There  he  reported  the  case  of  a  patient  suffering  from 


THE  GERMAN  WORK  197 

cancer  of  the  stomach  who  was  treated  with  trypsin  as 
well  as  by  other  means.  On  the  nth  of  December  the 
patient  was  discharged  from  the  hospital,  the  case  being 
regarded  as  one  of  either  great  improvement  or  recovery. 
This  I  record  merely  for  its  historical  interest.  No  amy- 
lopsin  was  employed,  the  preparation  of  trypsin  must 
have  been  extremely  imperfect,  and  I  very  much  question 
whether  the  patient  was  cured.  But  at  any  rate  this 
paper  informed  us  that  German  science  had  now  taken 
up  the  matter  in  its  clinical  aspect  also. 

Of  far  greater  significance  was  the  paper  by  Profs. 
Von  Leyden  and  Bergell,  published  in  the  Zeitschrift  fur 
kUnische  Medisin,  vol.  6i,  pp.  360-365,  1907.  Here  I 
will  attempt  to  epitomize  that  paper  in  my  own  words. 
I  need  hardly  say  that  I  earnestly  recommend  a  study 
of  the  original  to  the  seriously  interested  reader.  Hith- 
erto it  has  been  totally  ignored  by  the  British  Medical 
Journal,  despite  my  discussion  of  it  in  the  Daily  Mail, 
my  references  to  it  in  the  Pall  Mall  Gazette,  the  Morning 
Post,  and  the  Contemporary  Reviezv,  and  my  public  in- 
dictment of  the  Journal  in  the  Observer.  It  has  been  care- 
fully epitomized  and  discussed  in  the  Journal  of  the  Amer- 
ican Medical  Association,  and  in  France. 

The  authors  begin  by  observing  that  the  origin  and 
growth  of  cancer  is  always  strictly  local.  Its  unlimited 
power  of  growth  has  ever  been  its  most  striking  symptom, 
and  a  most  marked  feature  of  it  is  that  the  tumor  responds 
by  increased  growth  to  all  forms  of  mechanical  or  chemi- 
cal injury,  or  injury  by  heat,  hitherto  known.  We,  there- 
fore, are  compelled  to  suppose  that  the  really  important 
fact  for  us  to  ascertain  about  cancer  is  not,  let  us  say, 
the  shape  of  the  cells,  but  their  chemistry.  What  peculiar 
facts  are  there  about  the  chemistry  of  cancer  which  con- 


198    THE  CONQUEST  OF  CANCER 

stitute  the  essential  difference  between  it  and  normal  tis- 
sues? Such  facts  there  must  be,  and,  accordingly,  it 
must  be  possible,  in  theory,  to  exercise  a  special  action 
on  the  chemistry  of  cancer,  which  will  arrest  its  living 
processes  but  will  not  affect  the  chemistry  of  normal  tis- 
sues. Prof.  Von  Leyden  insists  that  we  must  abandon 
as  of  central  importance  the  study  of  the  appearance  of 
cancer  to  the  naked  eye  and  under  the  microscope.  For 
half  a  century  this  study  has  constituted  practically  the 
whole  of  cancer  research.  Medical  chemistry,  during  all 
this  period,  was  far  too  imperfect  to  be  of  any  avail.  The 
real  question  is.  What  sorts  of  substances  are  formed  by 
malignant  tumors,  whose  growth  we  are  not  able  to  stay? 
Now  the  authors  point  out  that  the  only  substances  found 
in  living  matter  which  show  a  far-reaching  specific  nature 
— that  is  to  say,  a  wide  distinctness  from  each  other — are 
the  albumins,  such  as  white  of  egg  and  the  albumin  of 
milk.  Secondly,  the  various  ferments  which  destroy  these 
albumins  are  equally  special  in  their  properties ;  probably 
they  differ  from  one  another  in  precisely  the  same  degree 
as  do  the  albumins  which  it  is  their  business  to  pull  down. 
The  question  then  arises  whether  there  are  unique  albu- 
minous substances  in  cancers — whether  the  albumins  of 
malignant  growths  are  substances  which  differ  in  build 
and  composition  from  the  molecules  of  the  other  albu- 
mins. This  question  has  already  been  answered  definitely 
by  Bergell  and  Dorpinghaus,  says  Von  Leyden,  who  have 
separated  peculiar  and  characteristic  albumins  from 
mouse-cancer.  Prof.  Von  Leyden  insists  that  the  exist- 
ence of  these  special  albumins  is  absolutely  characteristic 
of  malignant  tumors,  as  distinguished  from  innocent  tu- 
mors and  normal  tissues.  The  further  question  whether 
these  special  albumins  can  be  specially  destroyed  has  al- 


THE  GERMAN  WORK  199 

ready  been  answered,  as  I  have  said ;  tHus  confirming 
what,  on  theoretical  grounds,  Dr.  Beard  declared  must 
be  so,  on  December  13,  1904,  and  what  I  myself  have 
been  asserting,  on  the  grounds  of  Dr.  Beard's  theory  and 
my  own  clinical  observation,  since  March,  1906. 

Prof.  Von  Leyden  then  goes  on  to  point  out  the  bear- 
ing that  these  observations  of  his  have  upon  the  theory 
of  Dr.  Beard  and  his  experiments  on  cancerous  mice. 
In  the  light  of  these  experiments,  and  fortified  by  the 
observation  of  Blumenthal,  he  determined  to  go  very 
closely  into  the  clinical  investigation  of  the  new  remedy. 
Large  quantities  of  the  ferments  would  have  to  be  em- 
ployed. Von  Leyden  thought,  and  he  refers  to  the  experi- 
ments of  Billroth,  who,  some  years  ago,  made  hypodermic 
injections  of  iodine,  quinine,  and  some  other  substances, 
in  cases  of  cancer,  without  any  result.  Von  Leyden  set 
himself  to  prove  that  when  trypsin  was  given  by  the 
mouth,  a  certain  quantity  of  it  actually  passed  into  the 
blood.  He  found  with  certainty  that  trypsin,  given  by 
the  mouth,  could,  to  some  extent,  be  recovered  in  the 
urine,,  and  he  came  to  the  conclusion  that  by  mouth  ad- 
ministration it  is  possible  to  bring  much  larger  amounts 
of  trypsin  into  the  circulation  than  by  subcutaneous  in- 
jection. But  on  this  point  Prof.  Von  Leyden  has  prob- 
ably already  found  occasion  to  revise  his  opinion.  We 
must  remember  that  he  was  using  injections  made  from 
dried  trypsin,  and  I  have  no  doubt  that  those  which  he 
employed  were  practically  impotent,  compared  with  the 
best  mjections  now  on  the  market.  It  has  to  be  remem- 
bered, also,  that  in  whatever  dose  trypsin  be  given  by  the 
mouth,  its  exposure  to  the  normal  acid  of  the  stomach 
will  destroy  it,  and  only  by  very  careful  administration, 
at  a  time  when  it  is  probable  that  the  stomach  contains 


200     THE  CONQUEST  OF  CANCER 

no  acid,  can  it  be  hoped  to  pass  on  undestroyed.  It  would 
be  much  to  be  regretted  if  the  great  name  of  Von  Leyden 
were  to  encourage  practitioners  to  place  in  the  adminis- 
tration of  trypsin  by  the  mouth  an  amount  of  confidence 
which  I  am  not  certain  that  it  will  repay.  In  the  patients 
whom  Prof.  Von  Leyden  treated  there  were  reasons 
which  would  explain,  I  believe,  why  the  trypsin  adminis- 
tered could  escape  destruction  in  the  stomach,  because 
these  were  cases  of  cancer  of  the  stomach,  in  which  it 
is  known  that  the  organ  no  longer  produces  its  normal 
acid.  Therefore,  I  would  strongly  insist  that  this  paper 
of  Prof.  Von  Leyden's,  as  he  doubtless  would  himself 
admit,  by  no  means  definitely  proves  that  any  very  sub- 
stantial value  is,  at  present,  to  be  attached  to  the  admin- 
istration of  trypsin  by  the  mouth.  Would  that  one  could 
say  otherwise — as  perhaps  may  yet  be  said — for  if  the 
mouth  administration  were  really  effective,  nearly  all  the 
difficulties  against  which  we  are  struggling  would  dis- 
appear at  once  with  the  disappearance  of  the  need  for 
making  any  injections  at  all. 

Nevertheless  we  must  not  under-estimate  the  impor- 
tance of  the  positive  demonstration  that  trypsin  given  by 
the  mouth  can  be  absorbed  into  the  blood.  This  fact 
affects  us  as  regards  both  practice  and  theory.  It  shows 
that  the  oral  administration  of  the  ferments — for  we  may 
provisionally  assume  that  what  Von  Leyden  has  proved 
for  trypsin  will  be  true  of  amylopsin  also — is  perhaps  not 
to  be  relegated  to  a  position  quite  so  subsidiary  as  I  have 
hitherto  allotted  to  it.  Whilst,  on  the  other  hand,  I  desire 
to  avoid  any  statements  which  will  lead  the  practitioner 
to  regard  the  use  of  the  hypodermic  method  as  non-essen- 
tial— for  I  doubt  whether  by  any  other  means  we  can 
introduce  so  much  trypsin  into  the  blood — yet,  on  the 


THE  GERMAN  WORK  201 

other  hand,  I  am  well  aware  of  the  vast  advantages  of 
oral  administration,  both  as  regards  the  difficulties  of  the 
manufacturing  chemists,  and  as  regards  the  convenience 
and  ease  and  safety  of  the  patient.  By  mouth  adminis- 
tration it  is  possible  to  give  practically  unlimited  quanti- 
ties of  the  active  ferments,  without  risk  of  abscesses 
caused  by  dirty  methods,  or  of  destroying  the  ferment 
by  otherwise  faulty  technique.  The  first  patient  I  saw, 
who,  like  many  others,  declined  to  continue  with  injec- 
tions which  at  that  time  (February,  1906)  were  very 
painful,  might  conceivably  have  been  saved  if  the  mouth 
administration  had  been  pushed.  Let  it  be  remembered 
in  practice,  therefore,  that  considerable  quantities  of  the 
active  ferments  can  be  introduced  into  the  blood,  and 
therefore  necessarily  be  brought  to  bear  upon  the  growth, 
by  mouth  administration.  In  cases  of,  for  instance,  rap- 
idly growing  and  highly  malignant  sarcoma,  this  possi- 
bility, superadded  to  the  hypodermic  method,  may  turn 
the  scale  in  the  patient's  favor.  We  are  dealing  not  with 
a  poison — to  the  patient — but  with  a  literally  native  in- 
habitant of  the  normal  body ;  and  if  a  desperate  disease 
can  be  controlled  by  a  remedy  so  far  from  desperate,  we 
must  use  every  channel  in  our  power  for  its  application. 
It  is  to  be  doubted  whether  the  use  of  keratin  or  other 
capsules,  which  the  gastric  juice  cannot  digest,  is  ad- 
visable, since  not  infrequently  the  digestive  processes  of 
the  bowel  fail  to  digest  the  capsule,  and  the  remedy  is 
wasted.  It  is  possible  that  this  is  especially  liable  to 
occur  in  cases  of  cancer,  since  the  pancreatic  secretion, 
upon  which  we  rely  to  digest  the  keratin,  may  be  defect- 
ive. The  method,  then,  as  I  have  already  stated,  must 
be  to  give  large — very  large — doses  of  the  ferments  be- 
fore meals,  when  it  is  practically  certain  that  the  gastric 


W2  THE  CONQUEST  OF  CANCER 

contents  are  not  acid,  but  neutral  or  faintly  alkaline. 
The  difficulty  of  passing  the  ferments  undestroyed 
through  the  stomach  is  undoubtedly  less  in  cancer  than 
in  other  diseases  or  in  health,  since  recent  observations 
show  that  the  secretion  of  hydrochloric  acid  by  the 
stomach  is  diminished  or  abolished  not  only  in  cases  of 
cancer  of  the  stomach — as  has  long  been  known— but  in 
cases  of  cancer  generally.  I  submit,  then,  that  what  I 
have  said  formerly  as  to  the  mouth  administration  of  the 
ferments  must  not  be  considered  without  reference  to 
Von  Leyden's  recent  demonstration  that  active  trypsin 
can  be  recovered  from  the  urine  after  administration  by 
the  mouth. 

But  this  demonstration  is  also  of  very  considerable 
theoretical  importance;  and  though  the  primary  object 
of  this  book  is  therapeutic  and  practical,  we  may  briefly 
consider  this  point  here.  If  trypsin  reaching  the  bowel 
from  the  stomach  can  be  absorbed — the  physiology  of  the 
stomach  making  it  almost  certain  that  the  remedy  is  not 
absorbed  directly  through  the  gastric  wall  into  the  blood 
— then  we  know,  for  certain,  that  the  trypsin  normally 
formed  in  the  bowel  by  the  fermentation  of  the  pancreatic 
trypsinogen  by  the  intestinal  enterokinase,  can  also  be 
absorbed :  I  do  not  say  is  absorbed,  but  can  be  absorbed. 
Are  we  to  suppose,  then,  that  this  normally  occurs  to  any 
appreciable  extent? — or  that  it  only  so  occurs  when,  as 
presumably  in  the  observations  of  Von  Leyden,  the  bowel 
contains  an  excess  of  trypsin  ?  These  questions  are  really 
momentous.  They  suggest  the  possibility  that  there  may 
be  some  truth  in  the  speculation  of  a  former  chapter  re- 
garding the  greater  absorption  of  trypsin  from  what  I 
have  called  the  "Fletcherite  bowel" ;  and  they  also  lead 
us  to  ask  whether  the  age  incidence  of  cancer  has  any 


THE  GERMAN  WORK  203 

dependence  upon  a  conceivable  though  quite  unproved 
diminution  in  the  activity  of  the  pancreas.  It  may  be 
that  the  jagged  tooth  of  a  young  man  arouses  no  cancer 
in  his  tongue,  though  there  is  present  there  the  aberrant 
germ-cell  which,  similarly  irritated  thirty  years  later, 
would  almost  surely  develop  into  a  cancer — ^because  the 
young  man  is  protected  by  the  trypsin  absorbed  in  ade- 
quate quantity  from  a  bowel  supplied  by  a  vigorous  young 
pancreas. 

At  any  rate,  it  is  to  be  recognized  that  whatever  factor 
— diet  or  youth  or  any  other — facilitates  or  permits  the 
absorption  of  trypsin  from  the  bowel,  is  a  factor  directly 
tending,  on  Dr.  Beard's  theory  of  the  specific  toxic  action 
of  trypsin  on  cancer,  now  absolutely  established,  to  pre- 
vent the  occurrence  of  cancer.  Per  contra,  any  factor, 
such  as  overeating  with  intestinal  decomposition,  or 
senile  debility  of  the  pancreas,  which  interferes  with  such 
absorption,  removes  a  condition  which  inhibits  the  growth 
of  cancer,  and  thus  predisposes  to  it. 

Plainly  there  is  a  great  field  here  for  immediate 
physiological  research.  Is  trypsin  normally  present  as 
one  of  the  ferments  of  the  blood?  The  probable  answer 
is  affirmative.  I  am  well  aware  that  in  previous  writings 
I  have  advanced  arguments  which  tend  to  the  opposite 
conclusion.  That  matters  nothing,  for  my  opinion,  like 
all  opinions,  settles  nothing,  alters  no  truth :  I  can  merely 
state  what  I  believe  to  be  facts  and  arguments  which  I 
believe  to  be  valid  so  far.  If  the  reader  is  dissatisfied 
let  him  investigate  the  matter  and  instruct  us  all.  ^ly 
own  opinion  is  now  tending  to  the  view  that  trypsin  may 
— and  perhaps  should^novmdWy  be  absorbed  from  the 
bowel,  and  should  therefore  be  a  normal  inhabitant  of 
the  blood,  rapidly  excreted  by  the  kidneys,  no  doubt,  but 


^04)  THE  CONQUEST  OF  CANCER] 

rapidly  replaced,  during  the  daytime  at  any  rate.  For  if 
trypsin  be  normally  present  in  the  blood,  perhaps  only  in 
minute  quantities,  its  percentage  must  fall  to  zero  after 
a  longer  or  shorter  period  of  fasting,  when  no  more  is  be- 
ing produced,  while  its  excretion  by  the  kidneys  con- 
.tinues.  Here  is  a  further  opportunity  for  the  young 
physiologist. 

The  three  considerations  which  support  the  case  for 
the  normal  presence  of  trypsin  in  the  blood  are  now,  I 
think,  as  follows.  First :  it  would  have  a  value  and 
function  in  the  blood  as  a  preventive  of  cancer,  whilst 
formerly,  of  course,  we  knew  it  simply  as  a  ferment  pro- 
duced in  the  bowel  for  the  needs  of  the  bowel  alone. 
Second:  when  large  doses  of  tr3-psin  are  given  by  the 
mouth,  it  enters  the  blood,  as  Von  Leyden  has  shown. 
Third:  the  injection  of  normal  pig's  blood,  freed  from 
its  cells  and  fibrin,  under  the  skin  of  cancer-patients,  has 
been  proved  to  exercise  a  marked  and  unmistakable  con- 
trol over  the  disease.  This  is  the  recent  work  of  Prof. 
Bier,  which  falls  to  be  discussed  later  in  this  chapter. 

Even  if  trypsin  be  normally  present  in  the  blood,  it  by 
no  means  follows  that  it  usually  there  occurs  to  such  an 
extent  and  so  continuously  as  to  protect  us  adequately 
against  cancer — at  any  rate  in  man,  whose  digestive 
glands  are  doubtless  less  active  than  those  of  such  an 
animal  as  the  pig. 

After  this  long  digression,  Jiecessitated  by  the  impor- 
tance of  Von  Leyden's  observation,  we  must  return  to 
the  study  of  his  admirable  paper. 

Though,  as  I  believe,  Prof.  Von  Leyden's  method  of 
applying  the  treatment  was  very  far  from  satisfactory, 
he  has  convinced  himself,  and  asserts  in  this  paper  as  a 
proved  fact,  that  without  doubt  circumscribed  regions 


THE  GERMAN  WORK  205 

of  cancer  can  be  successfully  digested  by  trypsin  injected 
directly  into  the  tumor.  The  point  is,  of  course,  impor- 
tant, whether  the  action  is  one  of  true  specific  digestion, 
and  Prof.  Von  Leyden  promises  us  shortly  a  paper  by 
one  of  his  followers  which  proves  that  the  influence  of 
trypsin  on  the  growths  was  true  ferment  action  and  not 
confused  with  bacterial  disintegration.  He  goes  on  to 
say  that  his  results  are  inferior  to  those  which  might 
have  been  expected  from  the  work  of  Prof.  Morton, 
That  is  undoubtedly  so.  But  I  believe  inferior  results 
will  continue  to  be  obtained  until  it  is  realized  that  hypo- 
dermic injection  is  the  essential  method — at  present,  at 
any  rate.  Prof.  Von  Leyden  has  given  very  large  doses 
of  trypsin  by  the  mouth  for  months  in  various  cases  of 
internal  cancer,  and  has  nothing  definite  to  report.  I 
doubt  whether  in  such  cases  any  appreciable  portion  of 
active  trypsin  ever  approached  the  site  of  the  disease. 
No  matter  how  large  the  dose  and  how  active  when 
given,  the  acid  juices  of  the  stomach — which  is  seldom 
entirely  free  from  hydrochloric  acid  in  such  cases — would 
probably  destroy  it,  unless  the  trypsin  was  given  with 
such  special  precautions  as  wrapping  it  up  in  something^ 
which  the  gastric  juices  cannot  dissolve.  But  Prof.  Von 
Leyden  goes  on  to  say  that,  in  almost  every  instance, 
suitable  cases  of  gastric  cancer  reacted  favorably  to  the 
treatment,  and  he  is  prepared  to  admit,  despite  the  im- 
perfection of  his  results,  that  there  is  here  a  curative  in- 
fluence which  must  be  recognized.  In  the  course  of  his 
investigations  he  has  brought  out,  he  tells  us,  an  abso- 
lutely new  fact.  Perhaps  it  is  new  so  far  as  demonstra- 
tion is  concerned,  but  Dr.  Beard  and  I  have  been  pro- 
claiming it  for  a  long  time  past.  The  author  reminds  us 
of  what  he  began  by  saying — that  malignant  tumors  sub- 


206     THE  CONQUEST  OF  CANCER 

sequently  react  by  increased  growth  after  the  apphcation 
of  any  injurious  agent.  But  in  trypsin  he  finds  the  single 
and  ah-important  exception.  Never  has  a  tumor,  after 
partial  dissolution  of  its  cells  by  trypsin,  subsequently- 
reacted  by  increased  growth,  either  locally  or  generally. 
The  point  is  that  while  scores  of  substances  will  injure 
a  malignant  tumor,  such  as  the  surgeon's  knife,  and 
pastes  containing  arsenic  and  other  caustics,  here  in 
trypsin  is  an  agent,  injurious  to  cancer  like  them,  but 
differing  from  all  others  in  that,  after  its  use,  the  tumor 
(assuming  that  it  has  not  all  been  destroyed)  does  not 
respond  with  increased  growth.  Let  me  add  for  myself 
a  second  point  which  should  be  bracketed  with  this,  and 
which  Prof.  \'on  Ley  den  himself  suggests  by  his  refer- 
ence to  the  specific  action  of  radio-active  substances.  It 
seems  to  be  quite  certain  that  the  Rontgen  rays,  radium, 
and  the  allied  substances  have  a  specific  relation  to-  can- 
cer in  that  they  will  affect  it  more  rapidly  than  normal 
tissues;  but  in  trypsin  there  has  been  found  a  substance 
which,  whilst  specifically  digesting  and  destroying  ma- 
lignant tissues,  vv-hether  living  or  dead,  has  no  action 
Zi'hatever,  in  any  dose,  on  nor)}ial  living  tissues. 

I  have  already  ventured  to  offer  criticism  upon  the 
amount  of  stress  which  Prof.  Yon  Leyden  is  inclined  to 
lay  upon  the  use  of  trypsin  by  the  mouth,  and  I  must 
also  allude  to  the  fact  that,  up  to  the  publication  of  this 
paper,  Prof.  Yon  Leyden  had  taken  no  cognizance  of 
amylopsin.  Now,  except  possibly  in  the  most  superficial 
cases,  I  do  not  believe  that  trypsin  alone  will  ever  cure 
cancer.  No  one  yet  has  recorded  a  case  of  the  cure  of 
cancer  by  trypsin  alone.  The  actual  cures  already  re- 
ported have  been  obtained,  without  exception,  by  the  use 
of  trypsin  and  amylopsin. 


THE  GERMAN  WORK!  207 

The  very  next  paper  in  the  journal  to  which  I  have 
already  given  the  reference  deals  conclusively  with  a 
most  important  matter,  and  what  appeared  to  be  a  most 
serious  objection,  cutting  at  the  very  root  of  Dr.  Beard's 
theory.  For  more  than  a  year  past  I  have  been  much 
perturbed  by  the  very  definite  statements  made  in  the 
most  recent  text-books  of  physiology  that  when  ferments, 
including  trypsin,  are  injected  into  a  living  animal,  there 
is  promptly  formed  in  its  blood  in  each  case  an  anti- 
ferment  which  protects  the  animal  and  prevents  the  sub- 
stance injected  from  having  any  action  whatever.  I 
could  not  actually  believe  this  of  trypsin :  in  the  first 
place,  because  of  the  results  obtained  by  its  use,  and,  in 
the  second  place,  because  it  is  a  native  inhabitant  of  the 
body  of  every  one  of  us,  and  it  seemed  incredible  that, 
even  if  it  is  not  normally  absorbed  from  the  bowel,  the 
blood  should  treat  it  as  an  enemy  and  a  poison.  Now 
this  treatment  during  the  past  eighteen  months  has  suf- 
fered greatly  at  the  hands  of  critics,  of  whom  I  have 
already  spoken  in  plain  words.  I  will  offer  just  one 
proof  of  the  ignorance  of  these  critics — ignorance  not 
discreditable  to  any  one  Avho  remained  silent,  but  abso- 
lutely inexcusable  in  those  who,  knowing  nothing,  have 
dared  to  denounce  this  treatment.  During  all  this  time 
not  a  single  opponent  anywhere  has  offered  what  has 
hitherto  been  the  one  really  substantiated  argument 
against  the  treatment — namely,  the  statement  of  the 
physiologists  that  trypsin  injected  into  the  blood  would 
be  immediately  neutralized.  It  was  not  my  business  to 
draw  the  attention  of  the  critics  to  this  argument,  since 
I  did  not  myself  believe  it,  but  I  present  them  with  it  now 
with  much  pleasure,  and  with  the  answer  to  it.^     Drs. 

^I  drew  aUention  to  this  point  in  the  Daily  Mail  first  of  all.    If 


208     THE  CONQUEST  OF  CANCER' 

Schiitze  and  Bergell  have  made  experiments  on  rabbits 
extending  for  months,  and  have  repeated  those  made  in 
previous  years  by  other  observers.  They  find  that  all 
plant- ferments  when  injected  into  a  rabbit  produce  anti- 
ferments.  They  find  that  pepsin  injected  into  a  rabbit 
produces  an  anti-pepsin,  a  fact  which  any  one  might  have 
predicted  from  Dr.  Beard's  embryological  work  of  twelve 
or  fifteen  years  ago.  But  they  find  that  trypsin  injected 
into  the  rabbit  never  produces  any  anti-substances  at  all. 
The  anti-tr}^psin,  then,  of  which  the  books  speak  do  not 
exist,  though  I  do  not  say  that  an  anti-substance  might 
not  be  formed  if  trypsin  were  injected  into  a  plant.  Let 
the  reader  observe  the  contrast  between  pepsin  and 
trypsin  in  this  respect,  and  also  the  contrast  already  men- 
tioned between  pepsin  and  trypsin  in  respect  of  their 
action  upon  cancerous  tissue  in  the  test-tube.  All  these 
facts  fit  in  absolutely  with  Dr.  Beard's  theory  of  the 
trophoblastic  nature  of  cancer,  and  the  fundamental  an- 
tagonism between  pepsin  and  trypsin  in  the  history  of  the 
development  of  the  body.  That  this  research  should  have 
been  undertaken  clearly  shows  what  progress  we  may 
expect  now  that  the  work  of  Dr.  Beard  has  been  taken 
up  in  the  great  city  and  by  the  great  students  who  lead 
the  medical  science  of  the  world.  At  the  same  time  it 
will  stand  permanently  on  record  that  the  first  great 
results  in  human  patients  were  obtained  by  American 
phA-sicians. 

The  next  contribution  of  Prof.  Von  Leyden — with  Dr. 
Bergell — to  this  subject  is  to  be  found  in  the  Deutsche 

the  reader  is  surprised  tliat  I  thought  this  matter  suitable  for  the 
popular  press,  let  me  remind  him  that  I  should  have  written  in 
the  Hibbert  Journal  or  the  Police  News  had  I  had  the  opportunity 
of  doing  so.    Readers  of  both  die  of  cancer. 


THE  GERMAN  WORK  209 

Medmnische  Wochenschrift,  1907,  No.  23,  p.  913.  At 
the  moment  of  writing  it  is  of  course  impossible  to  say 
what  the  results  of  this  new  development  will  be.  We 
may  remind  ourselves  that  Von  Leyden  had  been  using 
preparations  made  from  dried  trypsin,  and  had  employed 
no  amylopsin.  The  results  he  obtained  were  very  far 
from  being  ideal,  but  there  were  definite  results.  It  has 
proved  that  certain  ferments  were  capable  of  specifically 
attacking  the  specific  albumins  of  malignant  growths, 
and  this  without  any  subsequent  reaction  on  the  part  of 
the  growth.  In  the  absence,  however,  of  ideal  results, 
Prof.  Von  Leyden  set  himself  to  ascertain  whether  any 
other  organ  of  the  body  would  yield  a  ferment  still  more 
effective  than  trypsin — or,  rather,  still  more  effective 
than  the  preparations  of  trypsin  which  he  employed.  We 
may  take  it  that  at  this  point  the  feasibility  and  the 
scientific  reasonableness  of  treating  cancer  by  ferments, 
as  originally  suggested  by  Dr.  Beard,  was  definitely  estab- 
lished in  his  mind;  and  it  was  the  liver  in  which  he 
thought  it  possible  to  find  a  ferment  more  potent  or  of 
wider  applicability  than  trypsin.  He  obtained,  then, 
from  the  livers  of  animals  a  ferment  (prepared  as  a  semi- 
solid substance  and  incapable  of  being  injected)  which, 
according  to  him,  possesses  the  power  of  dissolving  cer- 
tain peptones  which  are  not  attacked  by  trypsin.  (In 
point  of  fact,  an  intra-cellular  proteolytic  ferment  had 
already  been  found  in  the  liver  by  Jacoby.)  This  sub- 
stance was  introduced  by  means  of  a  spatula  into  the 
substance  of  three  highly  malignant  tumors.  In  each 
case  the  malignant  mass  was  dissolved  with  such  rapidity 
and  energy  that  the  reporters  compared  the  action  to 
that  of  nitro-glycerine— ^reminding  us  of  a  former  com- 
parison between   trypsin   and    dynamite.     So   powerful. 


210     THE  CONQUEST  OF  CANCER 

according  to  them,  was  the  action,  accompanied  as  it 
was  by  the  formation  of  poisonous  substances,  that  at 
the  time  of  publication  of  this  paper  the  authors  were 
concerning  themselves  with  the  discovery  of  means  by 
which  it  could  be  regulated  for  practical  use  in  the  treat- 
ment of  cancer. 

The  authors  declare  that  the  liver-ferment  in  question 
has  an  action  even  more  powerful  than  that  of  trypsin 
upon  the  cancerous  cell  and  its  albumins.  Further,  they 
declare  that  this  ferment  acts  with  far  more  power  upon 
living  cancer  than  upon  cancerous  tissue  in  the  test-tube 
— upon  cancer  in  vivo  than  upon  cancer  in  vitro:  a  state- 
ment all  but  incredible.  The  authors  further  suggest 
that  the  power  of  growth  of  cancer  depends  upon  the 
absence  of  this  ferment  from  the  body  of  the  cancerous 
patient. 

The  summary  of  the  paper  in  question  is  as  follows, 
as  accurately  as  possible:  The  proteids  of  cancer — or 
"proteins,"  to  use  the  modern  phraseology — are  specific 
albuminous  substances  of  which  the  destruction  by  dis- 
solution demands  the  intervention  of  agents  possessing 
a  specific  action  upon  them.  Secondly,  of  these  agents, 
which  belong  to  the  group  of  ferments,  one  which  is 
particularly  active  can  be  obtained  from  the  liver.  Its 
disappearance  from  the  body  of  the  cancerous  patient 
permits  a  new  growth  to  multiply  and  increase  without 
obstruction.  The  employment  of  this  ferment  in  the 
treatment  of  cancer  seems  to  be  possible. 

Now  what  is  to  be  said  at  the  present  stage  regarding 
these  latest  recorded  results  obtained  by  Prof.  Von  Ley- 
den?  Assuming  that  no  trypsin  in  any  form  is  used  in 
the  cases  in  question,  we  may  take  it  that  there  can  be 
obtained  from  the  liver  a  ferment  which  has  a  specific 


THE  GERMAN  WORK  211' 

action  upon  cancer.  It  seems  to  me  not  inconceivable 
that  this  ferment  may  actually  be  trypsin  or  a  form  of  it, 
possibly  absorbed  from  the  bowel  after  its  formation 
there,  and  reaching  the  liver  in  the  ordinary  way.  It  | 
will  require  to  be  demonstrated  that  this  substance  is  not 
trypsin.  A  weakly  acting  tryptic  ferment  was  found  some 
time  ago  in  bile  by  Bruno  and  by  Tschermak.  The  next 
question  that  arises  is  as  to  its  superiority — assuming  it 
to  be  different — to  trypsin  for  the  purpose  in  question. 
There  is,  of  course,  no  a  priori  impossibility  that  it  should 
be  superior,  still  less  that  there  should  be  more  ferments 
than  one  which  can  act  upon  a  given  albumin  or  group 
of  albumins,  just  as  both  pepsin  and  trypsin  will  digest 
certain  albumins,  or  just  as  both  the  ptyalin  of  the  saliva 
and  amylopsin  will  digest  certain  carbohydrates.  If, 
then,  a  ferment  more  powerful  than  trypsin  has  been  dis- 
covered, and  if  it  can  be  employed  in  such  a  fashion  as  to 
avoid  the  formation  of  an  excessive  amount  of  poisonous 
products,  so  much  the  better. 

But  at  the  present  time  I  am  inclined  to  question  these 
conclusions.  In  the  first  place.  Prof.  Von  Leyden  has 
been  comparing  this  liver-ferment — which,  for  the  mo- 
ment, we  may  assume  to  be  distinct  from  trypsin — witH 
injections  made  from  dried  trypsin,  the  potency  of  which 
was  not  estimated  in  digestive  units;  but,  if  we  may 
judge  from  what  we  know  of  dried  trypsin  as  a  basis  for 
injections,  was  probably  very  low.  Secondly,  Prof.  Von 
Leyden  employed  no  amylopsin.  This  ferment  has  been 
declared  by  all  who  have  reported  on  it — the  Middlesex 
Hospital  observers  excepted — to  control  the  toxic  symp- 
toms which  may  be  induced  by  the  use  of  active  trypsin 
in  cases  of  cancer.  Quite  possibly  it  would  have  con- 
trolled the  toxic  symptoms  induced  by  the  use  of  this 


21S     THE  CONQUEST  OF  CANCER 

liver-ferment,  the  toxic  substances  being  in  all  probabil- 
ity identical,  or  nearly  so,  since  in  both  cases  they  are  the 
results  of  the  action  of  a  proteolytic  ferment  upon  the 
characteristic  proteids  of  cancer. 

There  remains  the  theory  formulated  by  Prof.  Von 
Leyden  and  Dr.  Bergell,  that  it  is  the  absence  of  this 
ferment  from  the  liver  that  permits  the  growth  of  cancer 
in  any  given  case.  This  question  of  the  causation  of  the 
cell-multiplication  we  call  cancer  is  a  most  difficult  one, 
to  which  Dr.  Beard  has  declined  to  offer  any  answer,  and 
Prof.  Von  Leyden's  answer  to  it  evidently  does  not  affect 
either  in  one  direction  or  the  other  the  validity  of  Dr. 
Beard's  theory  as  to  the  trophoblastic  nature  of  malignant 
tissue,  and  its  origin  in  an  aberrant  germ-cell.  This 
theory  involves  no  statement  as  to  the  conditions  which 
induce  the  germ-cell  to  multiply  in  the  first  place,  nor  as 
to  the  conditions  which  permit  its  multiplication  to  pro- 
ceed unchecked  when  it  has  for  some  cause  or  other  been 
induced.  Each  of  these  is  a  question  still  awaiting  an 
answer.  If  it  be  that  Prof.  Von  Leyden  has  found  the 
answer  to  the  second  of  them,  so  much  the  better.  The 
validity  of  his  answer  is  evidently  capable  of  rapid  proof 
or  disproof,  since  it  would  appear  to  involve  nothing 
more  than  the  chemical  examination  of  the  liver  in  cases 
of  persons  who  have  died  from  cancer.  If  it  be  found 
impossible  in  such  cases  to  extract  this  ferment  from  the 
liver,  then  a  fact  of  the  greatest  importance  will  appar- 
ently have  been  discovered  in  the  elucidation  of  the  con- 
ditions which  permit  the  growth  of  cancer.  I  confess  at 
the  moment  to  much  doubt  that  this  result  will  be  ob- 
tained. I  also  confess  to  much  doubt  whether  the  use  of 
this  liver-ferment — though  it  seems  at  present  impossi- 
ble, in  the  face  of  Prof.  Von  Leyden's  authority,  to  ques- 


THE  GERMAN  WORK  21S 

tion  its  specific  action  upon  cancer — will  be  found  as  safe 
as  or  efficient  as  the  use  of  really  active  preparations  of 
trypsin  and  amylopsin. 

Such,  at  any  rate^  at  the  time  of  writing,  is  Prof.  Von 
Ley  den's  contribution  to  this  subject.  Its  value  as  con- 
firmation of  the  results  already  obtained  elsewhere  is  in- 
contestable, and  it  remains  to  be  seen  how  much  there  is 
in  it  which  constitutes  a  positive  advance  upon  the  work 
previously  done.  But  though  his  was  the  most  impor- 
tant of  the  earlier  German  papers  on  this  subject,  and 
though  I  have  naturally  used  his  name  and  authority 
since  last  June,  both  in  England  and  America,  in  the 
effort  to  gain  a  fair  hearing  for  the  new  treatment,  there 
can  be  little  doubt  that  certain  other  workers  in  Berlin 
have  made  contributions  to  it  of  equal  or  greater  weight, 
and  these  must  now  be  discussed. 

It  is  worthy  of  note,  in  passing  from  the  work  of  Von 
Leyden,  that  he  has  hitherto  been  the  chief  living  expo- 
nent of  the  parasitic  theory  of  cancer — the  theory  that  the 
disease  is  due  to  the  invasion  of  the  body  by  minute 
parasites,  as  are  so  many  other  diseases.  Prof.  Von  Ley- 
den, who  is  now  seventy-five  years  of  age  and  has  retired 
from  his  Chair  since  his  work  with  ferments  was  pub- 
lished, has  set  younger  men  a  fine  example  in  abandoning 
his  long-held  views  and  accepting  a  totally  new  series  of 
conceptions  in  regard  to  the  nature,  and  therefore  the 
treatment,  of  cancer. 

Prof.  Bier,  who  holds  the  Chair  of  Surgery  in  the 
University  of  Berlin,  the  foremost  surgical  Chair  in  the 
world,  is  noteworthy  as  by  far  the  most  distinguished 
surgeon — indeed  the  only  distinguished  surgeon — who 
has  yet  addressed  himself  to  the  treatment  of  malignant 
tumors   by   ferments.     His   method   of  treating   various 


214     THE  CONQUEST  OF  CANCER 

forms  of  local  tuberculosis,  especially  of  the  joints,  by 
stemming  the  return  of  the  blood  from  the  diseased 
part  through  the  veins,  is  known  and  practiced  all  over 
the  civilized  world.  He  attributes  the  utility  of  this 
method  to  the  increase  in  the  number  of  white  blood-cells 
which  are  thus  brought  to  bear  upon  the  invading  bacilli. 
It  is  possible  that  the  British  surgeons  who  have  so  con- 
sistently declined  to  attend  to  Dr.  Beard,  a  British  embry- 
ologist,  or  even  to  Prof.  Von  Leyden,  a  foreign  physician, 
may  listen  to  one  of  the  most  famous  and  highly  placed 
members  of  their  own  craft. 

In  the  Deutsche  Medisinische  JVochenschrift,  July  i8, 
1907,  there  appeared  a  paper  by  Prof.  Bier,  the  publica- 
tion of  which  was  hastened  by  the  previous  appearance 
of  A'on  Le3'den's  contributions  to  this  subject.  Some 
years  ago  Prof.  Bier  obtained  very  remarkable  results 
from  the  treatment  of  a  case  of  multiple  sarcoma  by  the 
injection  of  blood,  and  this  was  the  method  employed  in 
his  recent  experiments.  He  mainly  employed  the  blood 
of  the  pig — a  fact  which  especially  interests  us,  as  will  be 
seen — and  the  injections  consisted  of  from  ten  to  twenty 
cubic  centimeters  of  blood,  previously  freed  from  its 
white  cells,  and  from  the  constituent  called  "fibrinogen," 
which  clots  into  '"fibrin"  when  blood  is  drawn,  under  the 
action  of  the  fibrin-ferment  formed  by  the  white  blood- 
cells.  This  very  large  and  inconvenient  dose  of  "de- 
fibrinated"  blood  was  injected  subcutaneously — of  course 
with  minute  precautions,  especially  necessary  with  this 
method,  to  prevent  abscess-formation  or  other  infection 
by  microbes.  Marked  local  and  general  symptoms  o£ 
inflammation  follow  this  procedure,  lasting  for  some 
days;  and  such  blood-cells  as  remain  in  the  injected  blood 
are  destroyed,  together  with  many  of  the  blood-cells  of 


THE  GERMAN  WORK  S15 

the  patient.  This  result  of  the  injection  into  one  animal 
of  blood  from  another  species  of  animal  has,  of  course, 
long  been  known.  No  actual  disasters  occurred,  though 
the  process  must  have  been  extremely  painful  and  un- 
pleasant, besides  destroying  part  of  the  patients'  blood. 
Nevertheless  the  normal  tissues  of  the  patients  were  not 
injured  in  any  way,  any  more  than  they  are  by  the  injec- 
tion of  even  strong  solutions  of  trypsin  or  amylopsin. 

Highly  remarkable  and  characteristic  changes  were  ob- 
served, however,  in  the  malignant  tumors  from  which  the 
various  patients  were  suffering.  As  with  the  ordinary 
pancreatic  treatment,  pain  was  relieved,  discharge  was 
checked,  and  the  process  of  local  death  and  necrosis  of 
the  surface  of  the  exposed  tumors  was  arrested.  But  in 
several  instances  much  more  was  observed:  the  tumors 
appeared  to  die  and  degenerate  as  a  whole,  and  gradually 
diminished  instead  of  increasing  in  bulk.  In  more  than 
one  instance  something  not  far  short  of  an  actual  cure 
was  obtained.  Sometimes  the  growth  dried  up  and  died, 
even  in  advanced  cases,  and  the  cancerous  cells  disap- 
peared— neither  ulceration  nor  the  sloughing  of  merely 
dead  cancer-tissue  occurring.  In  other  cases,  there  was 
not  so  much  an  exodus  of  the  growth  as  its  replacement 
by  innocent  fibrous  tissue.  In  a  word,  the  results  were 
apparently  similar  in  detail  and  variety  to  those  observed 
by  the  earlier  experimenters  with  trypsin  and  amylopsin, 
and  especially  in  those  early  cases  in  which  amylopsin 
was  scarcely  employed  at  all.  The  specific  or  selective 
action  of  the  remedy,  killing  the  malignant  tissues  and 
not  affecting  the  normal  tissues,  is  specially  to  be  noted 
as  familiar  to  the  experience  of  Dr.  Beard's  followers. 

Prof.  Bier  fully  recognizes  that  these  results,  which, 
had  they  been  obtained  and  published  two  years  ago, 


216     THE  CONQUEST  OF  CANCER 

would  have  been  unparalleled,  were  obtained  by  the  action 
upon  the  living  cells  of  the  tumors,  of  a  ferment  or  fer- 
ments contained  in  the  blood.  Obviously  no  other  inter- 
pretation of  the  facts  would  be  possible,  even  if  these 
results  were  unprecedented.  At  the  very  least,  then,  they 
furnish  yet  one  more  independent  piece  of  evidence,  con- 
tributed by  one  of  the  very  first  of  living  surgeons,  of  the 
fact  that  it  is  possible  to  control  the  growth  and  even  the 
life  of  malignant  tumors  by  a  ferment  or  ferments  which 
exercise  a  strictly  selective  and,  in  this  respect  at  least, 
ideal  action,  injuring  only  the  tissues  which  are  injuring 
the  patient.  A  year  ago  such  results  as  these  would  have 
been  invaluable  to  me  as  an  argument  for  Dr.  Beard's 
cases;  and  even  to-day  they  may  be  commended  to  all 
concerned  as  positive  evidence  contributed  by  a  great 
surgeon,  and  obtained  in  a  quite  novel  fashion,  of  the 
main  thesis  of  this  book — that  ferm.ents  exist  which. can 
control  the  growth  and  life  of  cancer  without  injury  to 
normal  tissues. 

Before  we  consider  the  more  theoretical  significance 
of  these  experiments,  it  is  necessary  to  look  at  them  from 
the  practical  standpoint.  We  must  note,  then,  that  Bier's 
method  of  employing  ferments  has  not  hitherto  obtained 
results  in  any  way  superior  to  those  obtained  by  the  pre- 
vious method.  Further,  the  injections  cause  much  local 
and  general  disturbance  and  destruction  of  certain  ele- 
ments of  the  patient's  blood;  and  the  bulk  of  fluid  in- 
jected is  very  large.  I  have  little  doubt  that  the  ten  or 
twenty  cubic  centimeters  of  pig's  blood  used  by  Prof. 
Bier,  if  estimated  in  digestive  units,  would  be  found  far 
less  potent  than  is,  for  instance,  one  cubic  centimeter — 
the  usual  dose — of  the  medium  strength  injection  of 
Messrs.  Squire  &  Sons,  this  containing  five  hundred  units 


THE  GERMAN  WORK  ^V7 

(Roberts)  of  proteolytic  and  two  hundred  of  amylolytic 
activity.  We  may  well  believe  that  Prof.  Bier  is  doubt- 
ful of  obtaining-  cures  by  this  method,  though,  on  grounds 
about  to  be  discussed,  I  dare  say  that  if  the  pigs  be  fed 
■for  weeks  on  proteid  food,  and  the  blood  be  drawn  about 
three  hours  after  a  large  proteid  meal,  a  higher  concen- 
tration of  ferments  will  be  obtained.  But  even  so,  neither 
the  general  features  nor  the  results  of  this  method  make 
it  likely,  perhaps,  that  it  will  prove  more  effective  than 
the  pancreatic  treatment  as  hitherto  practiced  in  the  best 
hands. 

Turning  now  to  the  theoretical  questions  involved  in 
these  valuable  experiments,  we  must  inquire  into  the 
origin  and,  if  possible,  the  nature,  of  these  ferments  to 
which  Prof.  Bier  attributes  his  results.  We  may  agree 
with  him  that  the  blood  is  both  a  carrier  and  a  producer 
of  ferments.  It  is  known  that  the  white  cells,  aided  by 
the  presence  of  lime-salts,  are  able,  when  stimulated,  to 
clot  the  blood  by  the  formation  of  the  "fibrin-ferment." 
Prof.  Metchnikoff's  great  researches  into  the  function  of 
the  white  cells  also  suggest  that  they  are  capable  of  pro- 
ducing other  substances,  many  or  all  of  them  ferments, 
which  can  destroy  the  microbes  of  disease.  But  we  are 
without  evidence  of  the  external  production  of  any 
proteolytic  ferment  by  the  white  cells,  though  they  must 
contain,  within  themselves,  such  a  ferment  in  order  to 
digest  their  own  food.  The  only  other  living  elements 
of  the  blood,  the  red  cells,  are  purely  respiratory  in  func- 
tion, acting  as  oxygen-carriers,  and  though  they  con- 
ceivably produce  a  respiratory  ferment,  no  one  will  credit 
them  with  further  powers  in  this  direction.  The  white 
cells  were  removed  from  the  blood  injected  by  Prof.  Bier, 
and  the  red  cells  were  speedily  destroyed,  as  are  alien 


218     THE  CONQUEST  OF  CANCER 

cells  in  general  when  they  enter  the  blood.  We  may, 
therefore,  with  practical  certainty  exclude  the  blood  itself 
as  the  source  of  the  ferment  or  ferments  which  destroyed 
the  cancer-cells  of  Prof.  Bier's  patients. 

It  is  well  to  remember  that,  though  pathologists  and 
clinicians  most  misleadingly  speak  of  "diseases  of  the 
blood,"  and  though  this  fluid  is  too  commonly  regarded 
by  many  as  if  it  were  an  immediate  product  of  the  uni- 
versal ether,  in  reality  all  the  living  cells  of  the  blood  are 
made  elsewhere,  in  various  glands  and  in  the  red  bone- 
marrow,  whilst  its  fluid  part,  like  all  the  fluids  of  the  body, 
is  a  cell-product,  except  in  so  far  as  it  is  directly  derived 
from  the  food.  Now,  the  blood  being  a  ferment-carrier, 
as  Prof.  Bier  says,  and  the  origin  in  itself  of  its  cancer- 
destroying  ferment  or  ferments  being,  perhaps,  excluded, 
we  must  look  elsewhere  for  their  source. 

Von  Leyden,  Schiitze  and  Bergell  have  lately  taught  us 
that  trypsin  is  capable  of  absorption  from  the  bowel,  and 
that  when  it  is  injected  into  the  blood  it  is  treated  not  as 
a  stranger  but  as  a  native.  The  blood  reacts  to  all  for- 
eign substances  without  exception,  but  it  does  not  react 
to  trypsin.  Thus  the  probability  is  extremely  high  that 
trypsin,  formed  in  the  bowel  of  the  pig  from  the  tryp- 
sinogen  of  its  pancreas,  is,  in  part,  at  any  rate,  absorbed 
into  the  blood.  The  pig  must  not  be  credited  with  the 
unwise  dietary  habits  of  civilized  man,  which  provide 
him  with  a  rich  "intestinal  flora"  that  may  well  prevent 
the  absorption  of  much  trypsin,  if  any,  from  his  bowel. 
Further,  the  pig,  with  whose  blood  most  of  Prof.  Bier's 
results  were  obtained,  has  a  very  highly  active  pancreas ; 
and  whilst  he  was  relieving  cancer-patients  by  means  of 
the  ferments  contained  in  the  blood  of  the  pig,  Drs. 
Pinkuss  and  Pinkus,  and  many  others,  were  obtaining 


THE  GERMAN  WORK  S19 

similar  or  better  results  by  the  use  of  injections  made  from 
the  pancreas  of  the  pig,  which  is  the  animal  chiefly  em- 
ployed, on  account  of  the  activity  of  its  pancreas,  as  a 
source  of  the  pancreatic  ferments. 

Lastly,  we  have  to  remember  the  highly  specific  char- 
acter of  ferment  action,  and  the  fact  that  trypsin,  at  any 
rate,  is  one  specific  ferment  for  the  peculiar  albumins  of 
cancer.  Elsewhere  I  have  noted  Dr.  Beard's  argument 
from  the  vast  antiquity  of  trypsin  in  the  evolution  of  the 
animal  kingdom. 

When  all  these  considerations  are  appraised,  it  seems 
highly  probable  that  the  active  ferment  of  the  pigs'  blood 
used  by  Prof.  Bier  was  none  other  than  the  trypsin  formed 
from  the  pancreatic  trypsinogen  in  its  bowel  and  thence 
absorbed  into  its  blood.  This  is  why  we  may  surmise  that 
the  blood  will  be  found  more  actively  cancrotoxic  should 
Prof.  Bier  take  steps  to  heighten  the  activity  of  the  pig's 
pancreas  by  modifying  its  diet,  and  to  obtain  the  blood 
when  it  is  most  likely  to  contain  its  maximum  amount  of 
trypsin. 

The  same  argument  applies  to  the  other  animals  with 
whose  less  effective  blood  Prof.  Bier  experimented;  but 
the  special  fitness  of  the  pig  for  his  purposes  offers  a  sug- 
gestive coincidence  with  the  similar  fitness  of  which  the 
chemists  avail  themselves  in  the  preparation  of  trypsin. 

We  know  that  cancer  does  occur,  though  with  rela- 
tive rarity,  among  vertebrates  generally,  but  in  view  of 
the  known  activity  of  the  pig's  pancreas,  and  of  Prof, 
Bier's  results,  it  would  be  interesting  to  know  to  what 
extent  cancer  has  been  observed  in  the  pig,  while  the  pan- 
creas should  be  examined  post  mortem  in  any  cases  that 
ma,y  hereafter  be  observed.     Dr.  Beard  informs  me  that, 


220     THE  CONQUEST  OF  CANCER 

so  far  as  he  knows,  no  case  of  cancer,  or  of  identical 
twins,  has  been  recorded  in  the  pig. 

The  possibility,  then,  is  that  Prof.  Bier's  methods 
simply  constitute  a  variety  of  the  pancreatic  treatment, 
and  one  characterized,  so  far,  by  no  specially  favorable 
results  to  compensate  for  its  very  numerous  and  serious 
disadvantages  for  all  concerned — ^the  practitioner,  the  pa- 
tient, and  the  pig. 

It  is  conceivable,  of  course,  that  the  cancrotoxic  fer- 
ment of  pigs'  blood  may  not  be  trypsin,  but  may  be  a 
closely  allied  ferment  produced  in  some  other  organ  than 
the  pancreas.  This  possibility  is  perhaps  the  less  im- 
probable since  Von  Leyden  and  Bergell  have  apparently 
isolated  a  cancrotoxic  ferment  from  the  liver.  Possibly 
the  blood-ferment  is  one  and  the  same  as  the  liver-fer- 
ment, and  possibly  trypsin  is  the  real  name  of  both ;  pos- 
sibly all  three  are  distinct. 

Here  I  may  note  that,  though  Dr.  Beard  was  led  to 
indicate  the  use  of  ferments  in  cancer,  and  to  indicate 
trypsin  in  the  first  place,  because  he  observed  the  coinci- 
dence in  time  between  the  degeneration  of  trophoblast  and 
the  commencing  activity  of  the  pancreatic  cells  in  normal 
development,  there  is  no  a  priori  reason  why  the  liver  or 
the  thymus,-  or,  indeed,  any  other  gland,  should  not  also 
produce  a  similar  ferment.  It  will  remain  for  a  more 
advanced  chemistry  to  inform  us  as  to  the  composition 
and  structure  and  relations — or  possible  identity — of  such 
cancrotoxic  ferments  as  have  hitherto  been,  or  in  the  fu- 
ture may  be,  discovered.  If  such  ferments,  other  than 
trypsin,  are  discovered,  and  made  capable  of  therapeutic 

*In  the  Annals  of  Surgery  (Philadelphia,  July,  1907)  Dr.  Gwyer 
reported  favorable  results  from  the  use  of  the  thymus-gland  in 
cancer. 


THE  GERMAN  WORK  221 

employment,  and  if  they  prove  more  potent  than  trypsin, 
and  not  less  safe,  then  so  much  the  better.  I  hope  that 
neither  of  Dr.  Beard  nor  myself  may  it  be  said  that  we 
"mistake  the  horizon  for  the  end  of  the  world" ;  the  close 
of  the  first  or  pre-scientific  epoch  in  the  history  of  the 
treatment  of  cancer  is  doubtless  only  the  opening  of  an- 
other, controlled  by  the  rational  pathology  and  biological 
chemistry  of  Dr.  Beard's  conception. 

Before  leaving  Prof.  Bier's  work,  I  must  briefly  discuss 
a  further  consideration  to  which  it  gives  rise.  If  pig's 
blood  and  lamb's  blood,  for  instance,  are  cancrotoxic, 
why  should  not  human  blood  be  cancrotoxic  also?  The 
affirmative  answer  does  not  necessarily  follow  by  any 
means,  since  it  is  conceivable  that  the  crucial  factor  in 
Dr.  Bier's  experiments  was  the  employment  of  alien  or 
"heterologous"  blood.  This,  however,  is,  I  think,  ex- 
tremely improbable.  On  the  contrary,  it  may  be  ex- 
pected, in  my  judgment,  that  the  employment  of,  say, 
human  blood  derived  from  a  young  person  accustomed 
to  abundant  and  coarse  proteid  food,  and  possessed  of  ex- 
cellent digestive  powers,  would  prove  as  effective  as  the 
blood  of  the  pig.  Plainly  this  experiment  will  have  to 
be  made;  unless,  indeed,  it  should  become  evident  that, 
with  our  present  knowledge,  this  method  of  employing 
the  ferment  treatment  in  human  patients  is  no  longer 
legitimate. 

The  recent  German  work  includes  a  great  deal  of 
research  upon  the  chemistry  of  cancer  and  the  nature 
of  the  cancerous  cell.  This  work  afifords  the  most  strik- 
ing confirmation  of  Dr.  Beard's  contentions,  and  it  must 
be  discussed  here,  however  briefly.  But  meanwhile  it  is 
my  object  to  present  to  the  reader,  in  order  of  publica- 
tion, the  clinical  work  which  has  been  accomplished  in 


223     THE  CONQUEST  OF  CANCER 

the  treatment  of  cancer  by  specific  ferments,  whatever 
their  real  or  apparent  source ;  and  in  following  this  plan 
we  now  have  to  consider  what,  in  my  opinion,  is  certainly 
the  most  exhaustive  and  valuable,  as  well  as  the  most 
recent,  of  the  German  contributions  to  the  clinical  aspect 
of  this  subject.  In  this  case  there  is  no  doubt  as  to  the 
nature  of  the  ferments  employed. 

The  paper  in  question  appeared  in  the  Medisinische 
Klinik,  Nos.  28  and  29,  1907.  This  weekly  journal  can 
boast  the  most  illustrious  direction  of  any  now  extant, 
the  names  including  Profs.  Brandenburg,  Bier,  Von  Ley- 
den,  Ehrlich,  Fraenkel,  Gaffky,  Von  Mering,  Neisser 
and  Verworn,  whose  names  are  all  permanently  recorded 
in  the  history  of  medical  science ;  and  the  allotment  of  so 
much  space  to  this  paper  is  a  sufficient  index  of  the  im- 
portance which  is  attached  to  it.^  The  paper  is  entitled, 
"Die  Krebskrankheit  und  ihre  therapeutische  Beein- 
flussung  durch  Fermente"  (Cancer  and  its  Therapeutic 
Control  by  Ferments),  and  the  authors  are  Dr.  A.  Pin- 
kuss,  who  is  reporting  secretary  to  the  International  Can- 
cer Committee,  as  well  as  a  distinguished  clinician ;  and 
Dr.  S.  N.  Pinkus,  whose  former  experiments  on  the 
hypodermic  administration  of  trypsin  to  dogs  have 
already  been  mentioned.  I  will  attempt  to  summarize  the 
most  important  contents  of  this  paper. 

The  authors  begin  by  showing  how  Dr.  Beard's  embry- 
ological  doctrines  lead  to  the  advocacy  of  trypsin  and 
amylopsin  for  cancer,  and  they  quote  Von  Leyden,  Blu- 
menthal  and  Bergell  as  holding  that  the  chemical  question 
is  more  important  than  the  morphological  one — i.e.  the 

^I  note  this  point,  since  it  bears  upon  the  fact  that  it  was  left  for 
me,  "in  the  lay  press"  {Conteviporaty  Review.,  September,  1907),  to 
,draw  attention  to  this  article  in  Great  Britain. 


THE  GERMAN  WORK  223 

question  of  microscopic  appearances.  They  refer  to  Von 
Leyden's  work,  pointing  out  that,  though  locally  effective, 
his  procedure  of  making  local  injections  into  the  tumors 
could  not  lead  to  really  favorable  results,  because  of  its 
irrelevance  to  secondary  growths.  After  communicating 
with  Dr.  Beard  they  determined  to  take  up  the  use  of  the 
Fairchild  preparations  as  suitable.  Here  I  may  note  that 
their  results  were  thus  obtained  with  preparations  neces- 
sarily deteriorated  in  some  degree  by  the  time  occupied 
between  their  manufacture  in  New  York  and  their  em- 
ployment in  Berlin.  The  contrast  between  these  results 
and  those  obtained  by  Von  Leyden  from  preparations 
made  from  dried  trypsin  in  Germany  is  all  the  more  sig- 
nificant, as  is  the  fact  that  any  results  were  obtained  at  all. 
Proceeding  with  the  most  admirable  and  scientific 
method,  the  authors  first  set  themselves  to  prove  the 
harmless  character  of  the  preparations,  and  for  this  pur- 
pose they  made  injections  into  many  animals  and  into 
one  of  themselves.  Five  dogs,  two  guinea-pigs,  one  cat, 
and  one  rabbit  were  used.  The  following  table  gives  the 
results: 

Dog   (4.6  kg.) 5  c.c.  inject,  trypsin. 

Guinea-pigs  (220  and  280  grm.) i  c.c. 

Cat  (3.4  kg.) 3  c.c. 

Rabbit   (1.3  kg.) 3  c.c. 

There  were  no  abnormal  appearances  and  no  rise  of  tem- 
perature. Longer  experiments  were  then  made  on  sev- 
eral dogs  and  guinea-pigs. 

Dog  2   (ii  kg.)   reed,  on  38  days  16  injections  of  i  c.c. 
"      3   (6.5  kg.)   reed,  at  irregular  intervals  20  injections  of  i  c.c. 
"      4  (8.5  kg.)  (  reed,  for  4  weeks  i  grm.   "holadin"*  daily,  and 


"     5   (7.5  kg.)  (  each  6  trypsin  injections  of  3  to  6  c.c. 
*This  is  a  pancreatic  preparation  for  oral  use. 


224     THE  CONQUEST  OF  CANCER 

Two  guinea-pigs  (640  and  580  grm.)  received  in  24 
days  16  injections  of  -|  to  i  c.c.  There  was  no  fever  nor 
local  reaction  noticeable.  Dogs  3  and  5  were  found  to 
have  all  their  organs  normal,  the  pancreas  and  the  bowel 
being  microscopically  examined. 

Dogs  I,  2  and  4  were  injected  with  sterile  solutions 
of  other  ferment  preparations,  and  with  two  sterile  solu- 
tions prepared  by  the  authors  from  somewhat  decom- 
posed pancreas-glands.  Seven  guinea-pigs  also  received 
these  injections.  In  these  cases  one  or  two  injections 
sufficed  to  raise  the  temperature  markedly  for  long 
periods ;  there  was  marked  local  reaction,  far-reaching 
necrosis,  and  five  of  the  guinea-pigs  and  dog  4  died 
within  ten  days  with  all  the  symptoms  of  blood-poisoning. 
(It  is  particularly  to  be  noted  that  the  solutions  were 
sterile.)  In  the  other  two  dogs  and  two  guinea-pigs, 
five  injections  of  i  cc.  of  "injectio  amylopsini"  (Fair- 
child)  were  followed  by  a  lowering  of  the  temperature 
and  marked  relief  of  the  local  symptoms,  "whether  post 
hoc  or  propter  hoc." 

The  animals  which  received  the  Fairchild  trypsin 
showed  no  anti-trypsin  formation  (cf.  Schiitze  and  Ber- 
gell),  but  those  of  the  second  series  showed  in  their  blood- 
serum  more  or  less  strong  anti-tryptic  properties. 

In  many  of  the  above  cases  a  tryptic  ferment  could  be 
detected  in  the  urine. 

These  experiments  satisfied  the  authors  that  the 
Fairchild  preparations  were  not  poisonous,  and  this  was 
confirmed  by  one  of  them,  who  made  three  injections  into 
himself. 

Now,  say  the  authors,  we  could  begin  our  experiments 
on  cancerous  human  patients.  Of  course  they  confined 
themselves  to  cases  where  further  operation  was  out  of 


THE  GERMAN  WORK  225 

the  question.  They  began  with  some  of  their  own  cases, 
and  two  others  handed  over  to  them  for  treatment  by 
Prof.  Rinne  in  the  EHzabeth  Hospital,  Berlin.  This  was 
three  months  before  writing  their  present  preliminary 
report.  They  got  no  abscesses^  and  no  necroses :  the 
general  condition  of  the  patients  did  not  suffer ;  on  the 
contrary,  usually  their  appetite  and  spirits  were  improved. 
Various  reactions,  such  as  fever,  rigors  and  changes  in 
the  pulse  occurred,  but  these  were  always  found  to  dis- 
appear after  some  days'  use  of  amylopsin.  After  various 
periods  trypsin  was  found  in  the  urine.  The  authors  also 
studied  the  red  matter  and  the  white  cells  of  the  blood 
in  these  cases. 

The  following  four  cases  are  detailed  by  the  authors : 

Case  I. — Mrs.  F.  Inoperable  "portio"  cancer.  Septem- 
ber, 1906,  curetted  and  treated  with  caustics.  The  patient 
had  haemorrhage  and  pain  and  foul-smelling  discharge.  Un- 
der the  treatment  the  bleeding  ceased,  and  the  foetor  disap- 
peared with  remarkable  rapidity;  a  healing  process  set  in, 
and,  at  time  of  report,  had  been  going  on  for  nearly  three 
months.  The  treatment  was  being  continued.  Trypsin  was 
first  found  in  the  urine  after  48  injections.  (This  is  a  re- 
markable and  much  to  be  considered  observation,  in  my 
opinion.)  The  patient  had  her  first  rigor  and  fever  after 
42  days,  and  this  was  relieved  after  the  use  of  amylopsin. 

Case  2. — Mrs.  W.  Patient  had  worn  a  pessary  for  eight 
years,  and  had  developed  a  "portio"  (uterine)  cancer.  The 
womb  had  been  extirpated,  but  the  disease  extended  into  the 
vagina.  As  a  palliative  measure,  an  injection  of  trypsin  was 
made  every  third  day.  After  the  fourteenth  injection  rigor 
and  fever  appeared.  The  authors  merely  note  this  case  as 
showing  that  the  treatment  is  not  harmful. 

Case  3. — Male  patient,  age  58,  having  inoperable  cancer 
of  the  left  half  of  the  face  and  the  lower  jaw,  with  secondary 
growths.  The  "X"  rays  had  failed.  The  authors  say:  "In 
the  last  few  days  remarkably  favorable  changes,  obvious  to 
all  observers,   have  taken   place — softening  of  a  nodule  as 

^Cf.  the  Middlesex  Hospital  results  on  this  point  and  all  others. 


226     THE  CONQUEST  OF  CANCER 

large  as  a  cherry,  disappearance  of  the  swelling,  decrease  in 
the  infiltration — that  to-day  we  would  reserve  any  critical 
judgment.'"' 

Case  4. — Mrs.  D.,  age  38.  Cancer  of  breast  of  three  years' 
duration.  In  January,  1907,  operated  upon,  and  for  recur- 
rence in  April.  Patient  cachectic,  suffering  pain  all  over  the 
body,  and  under  morphine.  Probably  suffering  from  sec- 
ondary growths  in  the  abdomen  and  within  the  spinal  column. 
This  patient  received  daih^  injections,  and  after  sixteen  she 
has  not  yet  shown  any  general  reaction.  The  pains  have 
ceased,  the  appetite  is  improved,  less  morphine  is  given. 

The  authors  consider  the  preparations  used  by  them 
much  superior  to  those  used  by  Von  Leyden  and  Bergell. 
They  are  resolved  not  to  be  deterred,  even  if  they  experi- 
ence some  failures,  and  they  say  that  they  have  taken  up 
the  treatment  of  further  cases  in  the  Elizabeth  Hospital, 
Berlin.  They  recommend  other  ph3^sicians  to  take  up  the 
matter.® 

The  evidence  almost  daily  accumulates  to  such  an  ex- 
tent that  this  book  is  already  twice  as  long  as  was  planned 
when  I  began  it  a  year  ago;  and  I  cannot  afford  further 
space  to  the  consideration  of  this  invaluable  paper,  which 
contains  much  more  of  importance  than  I  have  referred 
to.  I  pass  now  from  the  more  especially  clinical  aspect 
of  the  German  work  to  another  which  is  less  arresting, 
perhaps,  but  of  the  first  im.portance  nevertheless. 

The  most  noteworthy  of  the  recent  German  contribu- 
tors to  the  more  purely  chemical  aspect  of  the  question, 
which  must  now  claim  us,  is  Prof.  Ferdinand  Blumenthal. 
At  the  end  of  the  chapter  will  be  found  the  references 
to  his  papers,  the  substance  of  which  must  now  be  stated. 

He  points  out  that  until  a  few  years  ago — a  very  few 
in  Great  Britain — the  pathologists  regarded   cancer  in- 

^If  the  student  will  read  and  compare  this  report  with  that  of 
the  Middlesex  Hospital,  he  will  wonder,  I  think,  whether  they 
really  belong  to  the  same  age  and  the  same  planet. 


THE  GERMAN  WORK  227 

vestigation  as  their  exclusive  domain.  The  minute  struc- 
ture of  malignant  tissue — i.e.  the  question  of  cell-shape, 
as  I  observe  elsewhere — and  the  mode  of  formation  of 
secondary  growths  were  the  chief  things  studied  by  them. 

The  cancer-cell  is  fundamentally  different  from  a 
tissue-cell,  Blumenthal  asserts,  on  many  grounds.  He 
totally  rejects  the  notion  of  Thiersch  and  so  many  after 
him  that  the  cancer-cell  has  something  degenerative  about 
it.  This  is  not  so;  and  it  is  certainly  not  a  degenerate 
form  of  tissue-cell.  Prof.  Blumenthal  rejects  the  "em- 
bryonal" theory  of  Cohnheim,  and  mentions  the  parasitic 
theory,  with  which  Prof.  Von  Leyden  was  so  prominently 
associated  until  the  work  of  Dr.  Beard,  followed  by  his 
own  and  that  of  his  own  assistants,  led  him  to  his  present 
views. 

Blumenthal  finds  no  evidence  of  a  "cancer-toxin"  in 
the  pressed  juices  of  a  cancer ;  but  he  refers  to  the  "can- 
cer-ferment" found  by  Petry,  and  observes  that  this 
ferment  can  be  destroyed  by  the  normal  ferment  found 
in  the  liver.  This  is  to  be  noted  in  relation  to  Von  Ley- 
den's  later  work.  But  Blumenthal  finds  that  the  self- 
digestion  of  the  liver  (by  its  own  ferment)  is  much  aided 
by  the  addition  of  chopped-up  cancer.  Neuberg  has  also 
shown  that  the  albumin  of  the  lung  is  digested  by  the 
ferments  of  liver  and  cancer  together.  These  results' 
seem  inconclusive,  if  not  contradictory,  and  we  may  re- 
mind ourselves  that  cancer  spreads  frequently  and  grows 
very  easily  in  the  liver.  Blumenthal  attributes  the 
cachexia,  or  general  poisoning  in  cancer,  to  the  entry  of 
the  cancer-ferment  into  the  blood.  But  it  has  to  be  asked 
how  far  this  cachexia  occurs  at  all  apart  from  bacterial 
infection  and  loss  of  blood, 

Blumenthal  goes  on  to  show  that  in  the  albuminous 


228     THE  CONQUEST  OF  CANCER 

matter  of  cancer  are  found  such  substances  as  alanin, 
phenylalanin,  aspartic  acid  and  di-amino-acids,  but  very 
little  leucin.  We  may  note  this  in  reference  to  the  possi- 
ble function  of  amylopsin  as  a  destroyer  of  some  of  these 
compounds. 

Blumenthal  shows  that  pepsin  digests  dead  cancer  in 
the  test-tube  scarcely  at  all,  while  trypsin  does  so  readily ; 
and  these  results  have  been  confirmed  by  Bergell  and 
Dorpinghaus,  and  by  Neuberg  and  Ascher.  In  his  judg- 
ment this  furnishes  a  chemical  indication  for  the  thera- 
peutic use  of  trypsin  in  this  disease.  That  further  ex- 
perience confirms  this  chemical  verdict  will  be  seen  when 
we  find  Prof.  Blumenthal  saying  later,  at  the  Heidelberg 
Cancer  Congress,  September,  1906,  that  "the  tryptic  fer- 
ment extremely  easily  dissolves  the  cancer-cells,  while  the 
very  opposite  property  is  the  case  towards  the  other  tis- 
sues"— i.e.  the  normal  body  tissues. 

Blumenthal  has  also  shown  that  the  black  pigment 
found  in  the  tumors  known  as  melano-sarcoma  is  not,  as 
was  assumed,  the  same  as  the  melanin  found  in  the  nor- 
mal body.  In  short,  all  Blumenthal's  work  goes  to  dem- 
onstrate a  radical  chemical  difference  between  the  cancer- 
cell  and  the  normal  epithelial  cell. 

In  comment  upon  the  foregoing,  which  constitutes  the 
general  results  of  Blumenthal's  work,  and  the  importance 
of  which  is  none  the  less  (though  quite  ignored)  in  Great 
Britain,  shall  we  say,  because  the  worker  happens  to  live 
in  Berlin  rather  than  London,  I  must  fix  upon  its  most 
important  statement,  that  of  the  specific  digestive  action 
of  trypsin  upon  cancerous  albumin  in  the  test-tube.  This, 
as  such,  furnishes  warrant  for  a  trypsin-therapeutics,  ac- 
cording to  Blumenthal ;  and  it  was  this  fact  which  deter- 
mined Von  Leyden  to  undertake  his  clinical  inquiry.    It 


THE  GERMAN  WORK  229 

alone  suffices  not  merely  to  recommend,  but  to  establish 
the  use  of  trypsin  locally  in  the  treatment  of  the  dead 
cancerous  tissue  which  is  so  lamentably  familiar ;  whereof 
the  admirable  and  rapid  results  may  be  observed  by  the 
least  skilful  and  the  most  skeptical.  I  am  absolutely  cer- 
tain that  trypsin  will  be  used  for  this  purpose  as  long  as 
cancer  exists ;  its  value,  therefore,  must  be  seen  to  be  ap- 
preciated. But  the  vital  question  is  as  to  the  relevance  of 
this  exhaustively  proved  fact  to  the  control  of  living 
cancer-cells.  These  indubitably  contain  the  albumins 
which,  when  they  are  dead,  trypsin  so  readily  digests  and 
destroys ;  and  no  one  wall  question  that  their  destruction 
in  the  living  cell  would  entail  its  death.  But  the  reader, 
whether  biologist  or  layman,  will  recognize  that,  though 
the  fact  first  noted  by  Blumenthal  is  conclusive  as  regards 
the  palliative  treatment  of  cancer,  it  is  not  conclusive  as 
regards  its  curative  treatment,  even  theoretically :  the 
point  involved  being  none  other,  indeed,  than  the  differ- 
ence, chemical,  physical,  electrical,  or  whatever  it  be,  be- 
tween life  and  death.  For  instance,  the  living  cell,  in 
virtue  of  its  chemical  activities,  might  have  the  power  of 
digesting  trypsin  itself;  and  this  might  conceivably  be 
effected  by  the  cancer-ferment,  if  indeed  it  is  not  for 
some  such  "purpose"  that  this  cancer-ferment  exists. 
Now  the  "malignin"  is  present  in  the  dead  cell — it  was 
originally  found  in  the  dead  cell,  and  necessarily  so;  it 
does  not  there  avert  the  action  of  trypsin;  and  on  these 
grounds  I  would  argue  the  probability,  though  on  these 
grounds  no  more,  that  trypsin  may  pull  down  the  albu- 
mins even  of  the  living  cell.  The  question  as  to  the  pos- 
sibility of  its  reaching  them  therapeutically  is  answered 
by  Von  Leyden's  demonstration  of  the  passage  of  trypsin 
into  the  blood  and  its  carriage  there  in  an  active  state. 


230     THE  CONQUEST  OF  CANCER 

There  can  be  little  doubt  that  it  can  pass  through  the 
walls  of  the  blood-vessels  from  within  outwards^^.^.  so 
as  to  reach  the  cancer-cells  themselves,  since  we  have 
proved  that  it  can  pass  through  them  from  without  in- 
wards— i.e.  when  it  is  absorbed.  Here,  however,  the 
chemical  work  leaves  us,  having  established  one  fact  of 
very  high  importance,  which  just  falls  short  of  being  the 
capital  fact — i.e.  the  digestion  of  the  living  cell  by  trypsin. 
I  believe  it  should  be  quite  possible,  however,  to  deter- 
mine even  this,  apart  from  clinical  inquiry.  Cancerous 
tissue  can  be  removed  and  inoculated,  as  we  know ;  in 
other  words,  it  can  live  for  a  time  apart  from  its  host,  of 
which  it  is  no  organic  part,  being  indeed  an  independent 
organism  of  independent  origin.  It  must  be  possible  to 
experiment  upon  this  living,  though  separated  tissue,  with 
fluids  containing  trypsin.  Physiologists  can  keep  sepa- 
rated organs  alive  for  hours  or  days  by  means  of  an  arti- 
ficial circulation.  Why  should  they  not  do  the  same  with 
organs  such  as  the  uterus  excised  by  the  surgeon  for 
cancer,  and  why  should  not  the  action  of  trypsin,  added 
to  the  nutritive  fluid  circulated  through  such  organs,  be 
observed?  There  is  room  here  for  good  and  noteworthy 
work.  Meanwhile,  however,  we  have  abundance  of  clin- 
ical evidence  which  shows  more  than  such  experiments 
at  the  most  could  show — namely,  that  cancer-cells  in  the 
living  patient  can  have  their  specific  albumin  digested, 
and  their  death  therefore  effected,  by  the  hypodermic 
administration  of  trypsin  at  a  distance,  if  not,  indeed, 
by  its  administration  by  the  mouth,  neither  injection  into 
the  tumor  nor  injection  directly  into  a  vein  being  neces- 
sary for  this  result.' 

''That  is,  as  a  rule.  These  methods  may  have  their  place  in  some 
cases.    The  latter  has  never  been  employed. 


THE  GERMAN  WORK  231 

I  would  recommend  further  experimentation,  which 
can  involve  little  difficulty,  with  the  cancer-ferment,  and 
with  the  ferments  of  various  cancers  and  sarcomas,  if 
these  differ,  as  I  suspect  they  do.  When  these  ferments 
are  obtained  in  the  test-tube,  let  us  expose  themi  to  trypsin 
and  observe  the  results.  It  may  be  predicted  that,  as  a 
rule,  if  not  invariably,  the  trypsin  will  be  found  to  destroy 
the  malignant  ferments ;  but  the  reaction  of  the  solution, 
whether  alkaline — favoring  trypsin — or  neutral,  or  acid, 
will  doubtless  be  found  to  be  a  factor  of  the  greatest 
importance,  probably  greater  than  the  question  of  con- 
centration. It  may  be  found  that  the  results  vary  with 
the  type  of  tumor  from  which  the  ferment  is  obtained, 
and  with  its  history  as  regards  stimulation  by  the  sur- 
geon's knife  or  other  means.  I  believe  that  such  experi- 
ments may  lead,  among  other  results,  to  valuable  knowl- 
edge regarding  the  desirability  of  what  seems  to  me  pos- 
sibly indicated,  viz.  the  use  of  alkalies  by  the  mouth  in 
order,  even  if  transiently,  to  increase  the  alkalinity  of 
the  body  fluids,  and  reduce  the  acidity  of  the  tumor  fluids, 
thus  aiding  the  curative  and  hindering  the  destructive 
ferment. 

Such  experiments  may  also  explain — on  the  assump- 
tion of  Blumenthal  regarding  the  causation  of  cancer- 
cachexia — the  consistently  amazing  influence  of  the  pan- 
creatic treatment  upon  the  general  state  of  cancer- 
patients,  transforming  their  appearance  and  the  value 
of  their  lives  to  themselves,  abolishing  the  characteristic 
tint  of  the  skin,  creating  appetite  and  increasing  the  body- 
weight.  Hitherto  I  have  inclined  to  attribute  these  re- 
sults, which  would  alone  suffice  to  make  this  the  greatest 
step  hitherto  taken  in  the  treatment  of  cancer,  to  the  con- 
trol of  septic  processes  by  the  treatment;  but  it  may 


232  THE  CONQUEST  OF  CANCER 

be  that  the  cachexia  of  cancer  is  really  a  specific  thing, 
and,  if  so,  it  is  very  likely  due,  as  Blumenthal  suggests, 
to  the  action  of  the  cancer-ferment  upon  the  blood  and 
the  tissues  to  which  the  blood  carries  it.  On  such  a  sup- 
position the  most  likely  explanation  of  the  wholly  unpre- 
cedented and  unique  action  of  trypsin  in  these  cases  is 
that  it  destroys  by  fermentation  the  cancer-ferment.  This 
surmise  should  be  capable  of  verification  or  refutation  in 
the  test-tube.  With  these  considerations  we  may  pass 
from  the  German  work  on  this  subject.®  It  is  highly 
characteristic  of  German  science,  it  is  by  far  the  most 
important  that  has  yet  been  done  in  the  investigation  of 
Dr.  Beard's  conceptions,  and  it  is  in  striking  and  signifi- 
cant contrast  to  the  scanty  and  purely  clinical  work 
which,  except  for  the  undescribed  and  unpublished  and 
therefore  scientifically  negligible  efforts  of  the  Imperial 
Cancer  Research  Fund,  is  all  that  can  be  recorded  in. the 
"prophet's  own  country." 

REFERENCES 

E.  Von  Leyden.    Ueber  die  Probleme  der  Kurativen  Behandlung 

der  Karzinome  (Zeitschr.  f.  Krebsf.,  1907,  p.  161). 
E.  Von  Leyden  and  P.  Bergell.  Verwendung  des  Trypsin  (Pan- 

kreatin)   bei  Karzinom   {Zeitschr.  f.  klin.  Med.,   1907, 

vol.  61,  p.  361). 
Ueber  Pathogenese  und  ueber  den  spezifischen  Abbau  der 

Krebsgeschwiilste  {Deutsche  Med.  Wochenschrift,  1907, 

No.  22,). 
A.  Bier.    Deutsche  Med.  Wochenschrift,  July  18,  1907. 

*At  the  time  of  writing  (September,  1907),  Drs.  Pinkuss  and 
Pinkus  are  making  trial  of  the  pancreatic  treatment  on  a  large 
scale  in  the  Elizabeth  Hospital,  Berlin;  prudence — or  cowardice — 
would  suggest  waiting  for  their  report,  and  doubtless  it  will  be  of 
grea  t  value,  but  as  cancer  will  not  hold  its  hand,  I  may  not. 


THE  GERMAN  WORK 

A.  PiNKUSS  and  S.  N.  Pinkus.  Die  Krebskrankheit  und  ihre 
therapeutische  Beeinflussung  durch  Fermente  (Medi- 
zinische  Klinik,  Nos.  28-29,  IQO?)- 

PAPERS    MORE    ESPECIALLY    CHEMICAL 

P.  Bergell.    Zur  Chemie  der  Krebsgeschwiilste,  in  Zeitschr.  fiir 
Krebsforschung,  vol.  5,  pp.  204-208.    (Paper  read  before 
International  Congress  on   Cancer,   Heidelberg,   Sept., 
1906.) 
F.  Blumenthal.   Die  chemische  Abartung  der  Zellen  beim  Krebs, 
in  Zeitschr.  fiir  Krebsforschung,  vol.   5,  p.    183,   1907. 
(Also  read  before  Inter.  Cong,  on  Cancer,  Sept.,  1906.) 
The  above  is  a  summary  of — 
Die  chemische   Vorgange  bei  der   Krebskrankheit,    in 
Ergebnisse  der  experitnentellen  Pathologic  und  Ther- 
apie,  vol.  i,  pt.  i,  1907,  pp.  65-104. 
Neuberg  and  Ascher,  in  Arbeiten  a.d.  Pathologischen  Institut  zu 
Berlin,  1906. 
[All  the  above,  except  Prof.  Bier,  who  has  not  used  tryp- 
sin (as  such),  confirm  the  observation  that  trypsin  has 
a  specific  toxic  action  upon  cancer.] 
For  further  recent  references  see  the  papers  of  Pinkuss 
and  Pinkus,  and  of  Blumenthal :  also 
E.    Petry.     Ein   Beitrag  zur   Chemie   maligner   Geschwiilste,   in 

Zeitschr.  f.  Physiol.  Chem.,  1899,  p.  393. 
J.  Beard.     Die  Embryologie  der  Geschwiilste,  in  Deutsches  Zen- 
tralblatt  f.  allg.  Pathologie,  1903,  vol.  14,  p.  513. 


CHAPTER  XVI 

SOME  RESULTS  RECORDED  HITHERTO 

In  the  present  chapter  I  propose  to  note  very  briefly 
some  of  the  more  important  results  which  have  hitherto 
been  recorded,  and  which  are  not  discussed  elsewhere. 
The  whole  of  the  German  results,  for  instance,  are  dealt 
with  in  another  chapter.  It  is  to  be  expected  that  the 
professional  reader  who  is  seriously  interested  will  avail 
himself  of  the  references  here  given^  and  I  shall  make  no 
attempt  to  deal  with  these  results  exhaustively. 

Adhering  approximately  to  the  chronological  order,  we 
may  begin  with  Dr.  Beard's  mouse  experiments.  The 
reference  here  is  the  British  Medical  Journal,  p.  140,  Jan. 
20,  1906,  where  will  be  found  a  brief  paper  by  Dr.  Beard, 
entitled  "The  Action  of  Trypsin  upon  the  Living  Cells 
of  Jensen's  Mouse-tumor."  It  was  this  remarkable  paper 
that  first  directed  my  active  attention  to  the  subject  of 
Dr.  Beard's  investigations,  but  it  is  of  interest  to  observe 
that  he  himself  undertook  the  experiments  merely  in  or- 
der to  direct  the  eyes  of  surgeons  and  pathologists  to  his 
earlier  and  more  fundamental  work,  and  regarded  the 
result  as  a  matter  of  course.  In  the  articles  which  I 
wrote  in  the  United  States,  and  which  led  to  action  there, 
I  laid  much  stress  upon  the  findings  in  the  mouse — ^but 
these  are  now  of  historical  rather  than  immediate  in- 
terest. 

"Jensen's  mouse-tumor"  took  its  origin  in  a  mouse 

234 


SOME  RESULTS  RECORDED     235 

about  four  years  ago,  and  has  since  been  the  subject  of 
exhaustive  study  by  Prof.  Jensen,  of  Copenhagen,  a  most 
distinguished  worker  in  this  field.  It  has  been  trans- 
planted into  some  thousands  of  mice^  the  majority  of 
which  it  has  killed.  Under  Dr.  Beard's  direction,  several 
mice  were  inoculated  with  tissue  from  this  tumor,  in 
November,  1905,  and  after  about  five  weeks,  when  seven 
or  eight  mice  had  developed  well-marked  tumors,  two 
were  made  the  subject  of  trypsin  injections.  The  re- 
maining mice  with  tumors  were  observed  for  compari- 
son— or,  as  we  say,  were  used  as  "controls."  I  will  quote 
Dr.  Beard's  own  description  of  the  results : 

"After  ten  days,  when  four  injections  in  all  had  been 
made  into  each  mouse,  one  of  them  was  found  dead  by 
the  laboratory  servant.  The  post-mortem  examination 
made  by  Dr.  Wade  revealed  no  cause  of  death.  But  for 
the  presence  of  a  tumor  mass  the  mouse  appeared  to  be 
quite  healthy.  The  laboratory  attendant  thought  that  it 
had  got  caught  between  the  cage  and  food  vessel,  and 
so  (when  intoxicated)  had  caused  its  own  death.  The 
microscopical  examination  demonstrated  that  every  sin- 
gle cell  of  the  tumor  was  in  degeneration,  fully  half  of 
them  being  represented  by  shapeless  masses  of  particles, 
probably  remains  of  nuclei,  and  all  the  rest  were  mere 
skeletons  of  cells.  Even  these  seemed  in  very  many 
cases  to  be  crumbling  and  falling  rapidly  away,  as  though 
in  a  hurry  to  quit  the  scene.  The  somatic  tissues  of  this 
mouse,  as  represented  by  the  leucocytes  (white  blood- 
cells)  and  connective-tissue  stroma  cells,  were  quite  nor- 
mal, and  in  the  following  instance  also.  The  treatment 
of  the  second  mouse  lasted  for  twenty-two  days,  when 
it  was  killed,  since  on  that  day  one  of  the  untreated  mice 
died  of  its  tumor.     In  the  case  of  that  mouse  the  tumor 


S36     THE  CONQUEST  OF  CANCER 

was  as  large  as  the  last  segment  of  a  man's  thumb,  while 
in  the  treated  mouse  it  was  only  as  big  as  a  lentil.  Mi- 
croscopically, this  latter  apolog}^  for  a  tumor  was  in  ad- 
vanced degeneration,  shrinking  away  to  nothingness,  and 
quite  harmless.  .  .  .  Even  without  further  treatment  the 
tumor  would  have,  in  all  probability,  been  absorbed  short- 
ly, or  its  remains  cast  out." 

Dr.  Beard's  results  were  confirmed  by  Dr.  G.  Zanoni, 
who  is  the  Director  of  the  Institute  Therapeutico  Italiano, 
at  Milan  {Gaszetta  degli  ospedali  e  delle  cliniche,  March 
i8,  1906).  As  the  whole  world  was  made  aware  through 
the  mouth  of  H.  R.  H.  the  Prince  of  Wales,  the  Imperial 
Cancer  Research  Fund  has  failed  to  obtain  these  results. 
I  write  in  October,  and  hitherto  no  notice  whatever  has 
been  taken  of  Dr.  Beard's  challenge  in  Nature  (Jan.  10, 
1907)  that  the  details  of  these  experiments  should  be 
published.  At  present  the  publication  of  these  results, 
without  the  evidence  for  them,  constitutes  interesting  in- 
formation about  the  Imperial  Cancer  Research  Fund,  but 
none  about  cancer. 

I  briefly  note  also  that  Dr.  Odier,  of  Geneva,  appears 
to  have  controlled  cancers  in  animals  by  the  use  of  pan- 
creatic ferments  (La  Semaine  Medicale,  Feb.  28,  1906; 
La  Presse  Medicale,  June  30,  1906). 

We  pass  now  to  malignant  disease  in  man. 

The  first  important  case  was  published  by  Dr.  Qarence 
Rice,  of  New  York  (Nezv  York  Medical  Record,  Nov. 
24,  1906,  p.  812) .  This  is  a  case  of  what  cannot  be  doubt- 
ed to  have  been  cancer  of  the  voice-box,  or  larynx,  and 
it  was  reported  cured.  Results  definitely  followed  the 
use  of  trypsin,  and  in  proportion  to  the  dose.  Dr.  Rice 
and  his  fellow-worker  remark  that  only  one  cause  for 
doubt  as  to  the  malignant  nature  of  the  growth  existed, 


SOME  RESULTS  RECORDED     237 

and  that  was  the  unprecedented  fact  of  its  cure  by  these 
means.  That,  however,  is  no  longer  an  argument.  Says 
Dr.  Rice:  "The  results  obtained  left  no  ground  for 
doubt  that  this  treatment  exerted  a  very  prompt  action 
upon  the  growth."  I  hear  (October,  1907)  that  this  pa- 
tient is  now  quite  well. 

The  next  paper  published  was  the  report  of  Prof.  Mor- 
ton {New  York  Medical  Record,  Dec.  8,  1906,  p.  893). 
This  paper  is  substantial  and  authoritative :  it  deals  with 
twenty-nine  cases  and  the  work  of  eight  months.  Though 
during  the  whole  of  this  period,  as  I  am  now  convinced, 
Prof.  Morton  was  using  doses  far  too  small,  he  had  most 
remarkable  results.  Certainly  his  report  is  the  most 
amazing  reading.  In  order  to  show  the  reader  the  quality 
of  his  results,  I  here  quote  the  greater  part  of  his  sum- 
mary: 

"Comments  upon  above  cases. — i.  Two  of  them,  cases 
10  and  14,  severe  cases  of  face  cancer,  are  cured  to  date 
by  the  use  of  trypsin.  .  .  . 

"3.  In  all  cases  signs  of  amelioration  in  the  progress  of 
the  disease  have  been  observed. 

"4.  Cases  I,  2,  3,  4,  and  8,  as  well  as  others  not  spe- 
cially recorded  among  the  hospital  cases,  demonstrate  that 
trypsin  produced  constitutional  reaction  characterized  by 
rigors,  shivering  fits,  fever,  pain  in  the  back,  sense  of 
weakness,  drowsiness,  etc.,  but  of  temporary  duration. 

"5.  Cases  I,  2,  3,  and  11,  among  others,  demonstrate 
beyond  question  that  trypsin  may  produce  local  reaction 
in  a  cancerous  tumor,  indicated  by  swelling,  heat,  pain, 
or  increased  discharge. 

"6.  Cases  20  and  21  demonstrate  that  enlarged  glands 
associated  with  cancer  have  rapidly  diminished  in  size 
under  the  influence  of  trypsin. 


^38  THE  CONQUEST  OP  CANCER 

"7.  It  has  already  been  pointed  out  that  these  cases 
were  mostly  absolutely  hopeless  at  the  time  of  beginning 
treatment. 

"8.  Rigors  and  increased  temperature  following  within 
a  few  hours  the  injection  of  trypsin,  is  an  encouraging 
sign,  since  it  indicates  that  the  cancer  has  been  attacked 
by  the  trypsin.  The  toxic  action  is  due  to  the  toxic  action 
of  absorbed  and  destroyed  cancer  products. 

"g.  Trypsin  has  a  decided  effect  in  reducing  cancer 
cachexia  (system-poisoning)  and  in  improving  the  gen- 
eral health. 

"10.  Trypsin,  in  many  instances,  as  notably  in  cases 
12,  13,  and  others,  demonstrates  that  even  in  severe  can- 
cer .  .  .  the  disease  may  be  brought  to  a  halt,  so  to  speak, 
even  if  the  patients  do  not  eventually  recover. 

"11.  The  use  of  trypsin  has  caused  haemorrhages  to 
cease  and  has  alleviated  pain. 

"12.  It  is  a  fact  that  the  patients  frequently  refer  their 
greatest  feeling  of  improvement  to  the  period  of  time 
when  they  are  taking  amylopsin  following  trypsin.  An 
important,  as  well  as  a  difficult,  feature  of  the  treatment, 
therefore,  is  to  reasonably  determine  the  proper  time  to 
administer  the  diastatic  ferment  as  well  as  the  requisite 
amount,  following  or  during  the  use  of  the  trypsin.  It 
has  seemed  to  me  that  the  pure  diastase  (injectio-amy- 
lopsini)  had  much  to  do  with  favorable  results." 

Prof.  Morton  came  to  an  unduly  optimistic  conclusion 
regarding  one  of  his  cases,  which  was  unfavorably  re- 
ported upon  some  time  later,  arousing  in  various  hostile 
quarters  a  chorus  of  the  most  malignant  delight.  One 
class  of  our  critics  have  exposed  their  motives  in  a 
highly  significant  fashion.  It  can  scarcely  be  a  matter 
of  satisfaction  that  some  one  has  not  been  cured  or  has 


SOME  RESULTS  RECORDED     239 

died  of  cancer;  it  can  scarcely  be  a  matter  of  satisfac- 
tion to  any  one,  seeing  that  it  may  be  his  turn  next,  that 
evidence  should  be  adduced  against  the  existence  of  a 
remedy  for  cancer.  When,  therefore,  a  writer  fails,  as 
the  writer  in  the  British  Medical  Journal  has  consistently 
failed,  to  conceal  the  pleasure  which  every  piece,  or  sup- 
posed piece,  of  adverse  evidence  affords  him,  it  is  a 
matter  of  the  simplest  psychological  inference  to  realize 
that  his  motives  are  personal,  and  not  only  personal,  but 
so  powerful  as  actually  to  overshadow  the  natural  desire 
which  every  one  must  possess  to  find  that  cancer  is  within 
reach  of  human  conquest.  It  is  the  unpleasing  but  in- 
evitable inference  from  a  host  of  articles  which  any  one 
with  nothing  better  to  do  may  now  refer  to,  that  there 
exist  persons  in  whom  the  emotion  of  joy  that  some  one 
else  has  not  discovered  a  remedy  for  cancer  outweighs 
all  other  considerations.  If  it  could  have  been  arranged 
that  the  treatment,  from  the  first,  should  be  discussed  only 
by  experts  who  themselves  happened  to  have  cancer,  we 
should  no  longer  be  at  the  present  stage  to-day.  This  is 
a  digression,  but  it  is  of  general  psychological  interest. 

Prof.  Morton  reported  a  further  case  in  the  New  York 
^Medical  Journal,  March  9,  1907;  two  operations  had 
been  performed,  and  the  patient  returned  in  September, 
1906,  with  a  new  small  nodule  situated  beneath  the  chin. 
This  was  treated  for  only  ten  days,  and  entirely  disap- 
peared, nor  was  there  any  return  of  it  three  months  later 
when  the  case  was  reported. 

In  the  Journal  of  the  American  Medical  Association, 
December  15,  1906,  Dr.  Wiggin  reports  a  case  of  sar- 
comatous tumor  of  the  tongue,  the  diagnosis  being  well 
confirmed,  which  was  treated  and  cured  by  trypsin  and 
amylopsin.    The  patient  was  independently  examined  by 


240     THE  CONQUEST  OF  CANCER 

two  doctors  eight  months  after  the  cessation  of  treat- 
ment, I  may  note,  and  no  trace  of  the  disease  could  be 
found.  The  next  American  case  that  may  be  referred  to 
is  that  recorded  by  Prof.  J.  T.  Campbell,  of  Chicago,  in 
the  Journal  of  the  American  Medical  Association,  Janu- 
ary 19,  1907.  In  this  case,  at  the  time  of  recording,  the 
cure  of  a  cancer  of  the  tonsil  and  tongue  was  almost  com- 
pleted. 

Dr.  Beard  himself  gave  a  brief  preliminary  report  of 
a  further  case  in  his  article,  "The  Scientific  Criterion  of 
a  Malignant  Tumor"  {New  York  Medical  Record,  Jan. 
5,  p.  24).  In  this  case  a  lady  living  in  Naples,  and  suf- 
fering from  inoperable  cancer  of  the  tongue,  was  treated 
under  the  care  of  four  distinguished  Italian  doctors.  So 
far  back  as  September,  1906,  the  last  remains  of  the 
growth  came  away,  and  Dr.  Guarracino,  a  prominent 
hospital  physician  of  Naples,  wrote  to  Dr.  Beard,  saying : 
"This  is  a  wonderful  result,  and  I  declare  that  it  seems 
to  me  the  most  considerable  fact  which  our  science  has 
ever  obtained."  I  write  in  October,  1907,  and  I  hear  that 
the  patient  is  now  entireh'  free  from  the  disease. 

The  reader  may  next  be  referred  to  a  long  article  by 
Dr.  Luther  of  the  University  of  Pennsylvania  {New  York 
Medical  Journal,  Feb.  23,  1907),  who  has  made  more 
than  five  hundred  injections  and  has  excellent  re- 
sults to  report.  Dr.  Luther  is  guilty  of  no  fulsome  cour- 
tesy toward  myself,  but  if  any  one  will  work  fairly  at 
this  question  he  is  heartily  welcome  to  say  what  he  likes 
about  me. 

Dr.  Qeaves'  article  {New  York  Medical  Record,  June 
ii)  is  elsewhere  referred  to.  Here  I  may  merely  note 
that  she  had  several  substantial  results  to  report,  fol- 
lowing upon  her  letter  of  nearly  six  months  before. 


SOME  RESULTS  RECORDED  124.1 

Still  keeping  to  the  United  States^  we  must  note  the 
case  of  Dr.  Doran,  also  of  New  York,  who  reports  in 
the  New  York  Medical  Record,  July  6,  1907,  a  case  of 
sarcoma,  a  terribly  malignant  tumor,  in  which  the  pa- 
tient underwent  the  pancreatic  treatment  for  recurrence 
of  the  disease  after  a  most  radical  and  extensive  opera- 
tion. The  treatment  was  begun  in  the  first  week  of  Janu- 
ary, 1907,  and  since  April  had  been  very  largely  relaxed, 
though  not  discontinued.  The  patient  had  gained  twenty- 
two  pounds,  and  scarcely  anything  whatever  could  be 
discovered,  at  the  time  of  reporting,  remaining  from  the 
recurrent  growths.  Here  is  a  case  where  surgery  had 
done  its  utmost,  and  where  nothing  else  in  the  whole 
armory  of  science  hitherto  could  have  availed  the  patient. 

Thirdly,  I  may  refer  with  equal  brevity  to  a  case  no 
less  remarkable,  reported  in  the  New  Orleans  Medical 
and  Surgical  Journal,  July,  1907.  In  this  case  a  cancer 
of  the  voice-box  or  larynx  had  been  excised  by  the  knife, 
but  recurred.  The  pancreatic  treatment  was  employed  for 
about  five  months,  at  the  end  of  which  time  no  disease 
could  be  found — nor  two  months  after  the  treatment  was 
discontinued. 

If  now  we  turn  to  Great  Britain,  the  record  will  be 
found  absolutely  in  accordance  with  what  any  student 
of  history  and  human  nature  might  have  predicted.  From 
Edinburgh,  for  instance,  where  Dr.  Beard  works,  there 
is  no  word  whatsoever  of  any  achievement,  or,  indeed, 
of  any  result  at  all.  I  ask  for  proper  detailed  records  of 
failure  wherever  obtained.  It  would  be  obviously  false 
to  say  that  they  will  be  as  welcome  as  records  of  success, 
yet  it  is  quite  possible  that  they  may  be  far  more  valuable. 
Edinburgh,  that  great  center  of  medical  science,  has 
nothing  to  say  for  or  against  the  ferment  treatment,  and 


242     THE  CONQUEST  OF  CANCER 

I  recall  the  historical  facts  which  attended  the  pioneer 
labors  of  Simpson  and  Lister  in  that  city. 

For  records  of  substantial  success  in  Great  Britain  we 
had  to  wait  until  a  few  days  after  the  publication  of  my 
article  in  the  Contemporary  Review.',  in  which,  after  re- 
cording results  in  Germany  and  /Vmerica,  I  had  scarcely 
more  to  say  as  regards  Great  Britain  than  that  results 
would  be  published  in  a  few  weeks.  On  August  31,  1907, 
the  British  Medical  Journal,  which  had  refused  to  pub- 
lish Dr.  Cavanagh's  report,  later  noted,  published  a  brief 
memorandum  by  Dr.  Cutfield,  which  may  be  noted  as  the 
first  of  its  kind  in  that  journal.  The  patient  had  been 
operated  upon  at  Guy's  Hospital  for  an  abdominal  tumor, 
rapidly  growing,  which  the  surgeon  was  unable  to  re- 
move, and  which  had  already  given  rise  to  various  sec- 
ondary growths  seen  at  the  operation.  The  treatment 
was  begun  on  the  ist  of  IMay,  under  Dr.  Beard's  direc- 
tions, at  which  time  "the  whole  epigastrium  appeared  to 
be  full  of  solid  tumor.  He  was,  besides,  wasting  rapidly, 
and  had  become  extremely  weak;  suffered  a  great  deal 
of  pain,  especially  in  the  back ;  had  nausea  and  vomiting, 
pain  after  food,  and  sleepless  nights."  Dr.  Cutfield  con- 
tinues as  follows :  "Very  soon  improvement  set  in,  and 
continued  steadily.  First,  the  vomiting,  nausea,  and  flatu- 
lence disappeared,  and  the  appetite  improved,  and  then 
gradually  the  pain  lessened,  and  the  swelling  also  steadily 
diminished,  while  the  weight,  which  was  recorded  weekly, 
regularly  increased.  The  injections  were  continued  daily 
for  three  months,  and  at  the  end  of  that  time  the  man 
was  practically  well,  the  only  symptoms  left  being  some 
abdominal  discomfort,  and,  occasionally,  pain.  He  eats 
and  sleeps  well,  and  attends  to  his  business  regularly; 
his  weight  is  only  a  few  pounds  less  than  it  has  been  for 


SOME  RESULTS  RECORDED     243 

many  years,  and  the  only  thing  to  be  felt  in  the  abdomen 
is  some  hardness  in  the  line  of  the  incision,  and  a  little 
to  the  left  of  it  the  remains,  I  suppose,  of  the  cyst  which 
was  left  stitched  to  the  abdominal  wall.  I  do  not  say 
that  he  is  cured,  but  no  one  who  has  seen  him  can  doubt 
the  immense  improvement  that  has  taken  place,  and,  con- 
sidering how  rapidly  he  was  deteriorating  before  treat- 
ment commenced,  and  how  promptly  and  steadily  the 
improvement  took  place  after  the  treatment  began,  it  is 
extremely  difficult  to  believe  that  the  trypsin  was  not  the 
cause  of  that  improvement." 

For  reports  much  more  extensive,  however,  we  must 
turn  to  the  General  Practitioner,  which  (June  15,  1907) 
had  already  discussed  the  significance  of  my  articles  in 
the  Daily  Mail  in  its  editorial,  which  may  be  heartily 
commended  as  a  rare  example  of  open-mindedness  and 
judgment.  I  only  wish  I  had  space  to  quote  it  in  full. 
On  August  31,  1907,  this  journal  published  a  preliminary 
report  "On  the  Pancreatic  Treatment  of  Cancer,"  by  Dr. 
Henry  Meggitt,  who  has  been  practicing  the  treatment 
since  December,  1906  (having  begun  it  the  day  after 
the  appearance  of  my  Pall  Mall  Gazette  article),  and 
under  my  eyes  since  January,  and  who  records  the  results 
hitherto  obtained  in  six  cases,  of  which  four  had  previ- 
ously been  the  subject  of  extensive  surgical  operation 
at  very  skilful  and  well-known  hands.  All  these  patients 
were  admittedly  past  all  surgery,  and  in  them — as  indeed 
in  the  other  two — the  nature  and  the  high  activity  of  the 
disease,  on  coming  under  treatment,  was  utterly  beyond 
the  vestige  of  question.  The  professional  reader  must  be 
referred  to  that  report.  I  may  quote  a  word  or  two  here 
from  the  general  remarks  included.  "In  all  cases  I  have 
seen  I  have  not  yet  met  with  one  that  has  not  obtained 


244i  THE  CONQUEST  OF  CANCER 

benefit.  Trypsin  has  absolutely  done  away  with  morphia. 
The  patients  eat  better,  they  feel  better  and  happier,  and 
put  on  weight.  As  a  general  practitioner  of  fifteen  years, 
I  look  back  with  horror  to  the  old  days  of  treatment,  when 
nothing  was  done  but  injections  of  morphia,  and  the 
sooner  the  patient  was  dead,  and  out  of  his  pain  and 
misery,  the  better  for  everybody.  .  .  .  Trypsin  will,  I  am 
confident,  if  intelligently  injected,  relieve  all  pains  of  can- 
cer, it  will  quickly  remove  all  fcetor  and  discharge  from 
broken-down  growths  when  applied  both  locally  and  hy- 
podermically.  By  the  end  of  two  months'  injections 
marked  improvement  in  glands  will  be  noticed;  they  be- 
come smaller  and  softer.  The  size  and  hardness  of  the 
tumor  itself  at  the  same  time  shows  marked  shrinking. 
The  general  health  improves  in  what  I  can  only  describe 
as  a  startling  way.  Cachexia  disappears  entirely,  weight 
is  put  on,  the  appetite  is  good,  and,  as  there  is  never  any 
pain,  the  patients  sleep  well." 

In  the  General  Practitioner  for  the  following  week, 
September  7,  1907,  there  was  published  the  report  of 
Dr.  Francis  Cavanagh's  two  cases  which  the  British 
'Medical  Journal  refused  to  publish.  The  first  patient  had 
had  a  cancer  of  the  stomach  for  two  or  three  years,  with 
all  its  typical  accom.paniments — pain,  sleeplessness,  ca- 
chexia, and  emaciation,  and  with  large  and  hard  glands 
in  the  groin.  The  patient's  weight  on  coming  under  treat- 
ment was  6  stone  10  lbs. ;  the  general  condition  was  such 
that  the  operation  recommended  by  a  consultant  could  not 
be  performed.  The  patient  said  that  her  pain  had  been 
practically  continuous  for  over  a  year,  and  it  prevented 
her  from  ever  sleeping  for  more  than  one  hour  at  a  time. 
Dr.  Cavanagh  says : 

"Within  a  week  of  beginning  injections,  pain  was  re- 


SOME  RESULTS  RECORDED     £45 

lieved  to  the  extent  of  allowing  the  patient  to  sleep  for 
six  consecutive  hours.  For  over  sixteen  weeks  now  the 
pain  has  totally  disappeared,  sleep  is  perfectly  normal, 
appetite  greatly  improved,  the  cachectic  skin  has  become 
quite  healthy-looking,  the  tumor  has  decreased  to  half  its 
original  size,  the  glands  are  much  smaller  and  softer,  and 
the  patient  has  gained  pounds  in  weight.  .  .  .  The  cessa- 
tion of  pain  and  the  improvement  in  this  patient  dated 
from  the  beginning  of  Dr.  Beard's  treatment,  and  this 
treatment  was  the  only  factor  that  was  superadded  to  the 
patient's  previous  mode  of  Hfe." 

In  the  second  case  an  abdominal  operation  had  already 
been  performed,  and  showed  "a  most  extraordinary  can- 
cerous and  irremovable  condition."  A  palliative  short- 
circuit  (gastro-enterostomy)  was  made.  A  fortnight 
later  the  patient  was  attacked  with  most  severe  pain,  *'at 
first  related  to  meals,  then  more  continuous,  till  at  last 
it  persisted  without  cessation  for  three  weeks,  and  her 
nights  were  spent  writhing  in  agony  on  the  floor.  Mor- 
phia said  to  be  useless ;  certainly  repeated  thirty  minim 
doses  of  tr.  opii  were  ineffectual.  .  .  .  The  patient  was 
injected  with  trypsin  at  a  time  when  she  was  still  in  that 
pain,  which  had  lasted  for  three  weeks.  The  pain  dis- 
appeared that  day.  .  .  .  Three  days  from  the  first  injec- 
tion had  an  attack  of  pain  for  two  hours,  then  was  quite 
free  for  six  weeks.  .  .  .  The  attacks  of  pain  still  occur, 
but  they  are  readily  overcome,  and  she  sleeps  well  every 
night.  ...  It  cannot  be  expected  that  this  patient  will 
survive,  though  she  is  now  quite  able  to  go  about;  it  is 
certain,  however,  that  she  would  have  been  dead  before 
now  but  for  trypsin  and  amylopsin." 

These  are  the  cases  which  the  British  Medical  Journal 
refused  to  publish  in  circumstances  which  I  detail  else- 


MG  THE  CONQUEST  OF  CANCER 

where.  I  submit  the  fact  to  the  judgment  of  public  and 
professional  opinion.  I  agree  that,  as  the  journal  said 
in  refusing  them,  they  are  ''incomplete."  But  I  will  ob- 
serve that  the  object  of  this  treatment  is  not  to  convince 
anybody  of  anything,  but  to  help  the  otherwise  helpless. 
In  my  judgment,  which  I  believe  universal  opinion  will 
sustain,  the  refusal  to  publish  these  cases,  after  a  failure 
to  acknowledge  their  receipt  for  three  weeks,  and  then 
only  on  Dr.  Cavanagh's  inquiry,  is  disgraceful. 

In  the  same  issue,  the  General  Practitioner  devoted  its 
leading  article  to  this  subject,  and  thus  describes  the  con- 
clusion at  which  it  has  arrived :  "This  conclusion  is,  with- 
out at  this  moment  considering  the  possibility  of  ultimate 
cure,  that  the  action  of  trypsin  and  amylopsin,  when  prop- 
erly administered,  is  undoubtedly  in  the  direction  of 
ameliorating  the  more  distressing  accompaniments  of 
cancerous  disease,  most  notably  the  pain.  On  such 
grounds  alone,  therefore,  the  method  would  be  amply  jus- 
tified." The  journal  goes  on  to  note  that  the  observers  at 
the  Middlesex  Hospital  "invalidated  their  own  report  on 
this  question  by  self-convicting  themselves  of  faulty  tech- 
nique. If  there  is  one  point  that  is  insisted  on,  not  only 
by  our  own  contributors,  but  by  the  German  investigators, 
it  is  that  necrosis  and  suppuration  should  never  occur  at 
the  seat  of  injection.  Yet  this  very  fault  caused  by  the 
administrator  is  one  which  the  Middlesex  Hospital  has 
urged  against  the  method!"  In  a  letter  to  the  General 
Practitioner  of  the  following  week.  Dr.  Dickinson  pointed 
the  moral,  concluding  his  letter  thus :  "Probably  the  in- 
flammatory process  set  up  by  septic  injections  destroys 
the  ferment  and  nullifies  the  treatment.  Thus  the  pro- 
fession and  the  public  are  being  misled."  This  comment 
upon  the  Middlesex  Hospital  report,  I  may  remark,  ex- 


SOME  RESULTS  RECORDED     S47 

ceedingly  obvious  and  radical  though  it  be,  is  the  first  that 
has  anywhere  appeared,  apart  from  Dr.  Beard's  and  my 
own  communications  "in  the  lay  press." 

The  editorial  writer  goes  on  to  observe  that  In  my 
Contemporary  Review  article  I  was  unable  to  quote  evi- 
dence from  English  sources,  and  in  the  following  sen- 
tences reasserts  the  contention  which  I  put  forth  in  the 
Observer:  "For  this,  in  our  opinion,  the  British  Medical 
Journal,  on  account  of  the  attitude  assumed  by  it  in  the 
beginning,  is  largely  responsible.  The  busy  doctor  has 
not  time  of  himself  to  read  even  the  original  articles  re- 
garding discoveries  or  theories,  much  less  to  reinvesti- 
gate their  bases,  so  that  his  medical  journal  has  a  great 
responsibility,  since  to  it  he  naturally  turns  in  his  desire 
to  keep  up-to-date.  What  his  journal  condemns  must 
naturally  affect  his  own  opinion,  and  the  condemnation 
of  trypsin  has  been  much  more  than  tacit." 

It  will  be  readily  understood  that  the  British  Medical 
Journal,  which  found  itself  unable  to  reply  to  my  Ob- 
server indictment,  later  to  be  noted,  has  made  no  answer 
to  this. 

Some  general  remarks  fall  to  be  made  here.  In  the 
first  place,  the  reader  will  not  confuse  the  statement  of 
these  results  with  any  assertion  as  to  their  ultimate  sig- 
nificance. It  is  indisputably  right  that  they  should  be 
stated.  They  prove  abundantly,  I  hold,  that  beneficial 
results  have  been  obtained  by  the  ferment  treatment.  On 
the  other  hand,  from  my  own  point  of  view,  it  would 
really  be  far  more  profitable  to  discuss  the  details  of  fail- 
ures, with  the  object  of  ascertaining  their  cause.  It  is 
much  to  be  regretted  that  properly  reported  records  of 
failure  are  as  yet  nowhere  to  be  found,  so  far  as  I  know ; 
records  such  as  that  of  the  Middlesex  Hospital,  which 


248     THE  CONQUEST  OF  CANCER 

tell  us  nothing  as  to  the  urine,  let  alone  the  blood,  of  tHe 
patients,  and  which  issue  in  the  warning  against  local 
disasters,  for  which  there  exists  absolutely  no  excuse — 
are  of  small  profit.  If,  on  the  other  hand,  we  had  records 
of  cases  in  which  the  treatment  was  applied  in  adequate 
and  cleanly  fashion,  but  without  good  results,  these  of 
course  would  be  of  the  utmost  value  in  helping  us  to 
form  an  estimate  of  the  range  of  application  of  the  new 
treatment.  If  some  of  its  advocates  should  be  inclined 
to  form  an  unduly  favorable  estimate  of  its  applicability, 
they  are  fully  entitled  to  point  out  that  their  judgment 
has  necessarily  been  affected  by  the  absence  of  recorded 
failure  where  the  treatment  has  been  properly  applied. 
If  by  chance  such  failure  cannot  be  recorded,  except,  as 
is  very  probable,  in  cases  of  which  the  malignancy  has 
been  factitiously  enhanced  by  surgical  or  other  irritation, 
then  so  much  the  better. 

Certain  of  the  cases  above  recorded  purport  to  be  cases 
of  cure ;  but  I  wish  to  insist  as  plainly  as  I  can  that,  if  no 
case  of  cure  nor  of  amlhing  resembling  cure  had  been 
reported  or  was  ever  to  be  expected,  the  beneficial  results 
of  the  treatment  would  still  entitle  us  to  claim  for  it  a 
universal  place  in  the  treatment  of  cancer.  If  it  will 
give  ease  for  agony,  sleep  for  sleeplessness,  sweetness  for 
foetor,  even  without  postponing  death  for  a  single  hour 
— even  so  it  will  be,  on  the  whole,  immeasurably  the 
greatest  boon  that  science  has  yet  offered  to  the  cancer 
patient.  To  refuse  to  relieve  pain  because  you  are  not 
sure  that  you  can  cure  the  disease,  is  a  wholly  imbecile 
and  brutal  proceeding,  which  is  countenanced  in  no  other 
case,  and  the  advocacy  of  which  I  think  no  one  could 
have  anticipated  before  this  question  was  raised.  The 
introduction  of  nitrites  was  the  greatest  step  ever  taken 


SOME  RESULTS  RECORDED  249 

in  the  treatment  of  angina  pectoris;  the  introduction  of 
digitalis  the  greatest  step  ever  taken  in  the  treatment  of 
heart-disease.  These  drugs  are  universally  used  and  ap- 
plauded, and  are  of  immense  service  to  mankind.  Neither 
of  them  is  in  any  sense  whatever  curative.  Let  all  the 
records  of  cure,  or  apparent  cure,  or  approach  towards 
cure  in  this  chapter  be  wholly  discredited :  even  then  the 
control  of  the  distressing  symptoms  of  cancer  by  the  fer- 
ments entitles  them  to  rank  in  the  treatment  of  this  dis- 
ease as  wholly  on  a  par  with  digitalis  in  heart-disease,  or 
the  most  valuable  known  remedies  so-called  in  the  treat- 
ment of  all  other  diseases  except  those  very  few  for  which 
curative  remedies  exist.  If  this  book  were  written  solely 
in  advocacy  of  a  remedy  for  the  pain  of  cancer  superior 
to  morphine,  and  if  that  sole  claim  were  to  be  upheld,  the 
volume  would  have  far  more  than  justified  its  appear- 
ance, and  every  criticism  it  contains  of  those  who  have 
opposed  the  treatment. 

In  passing  these  sheets  for  the  press,  I  take  the  oppor- 
tunity of  noting  what  constitutes  the  report  of  the  tenth 
case  published  in  Great  Britain  since  my  Contemporary 
Review  article.  This  is  to  be  found  in  the  Medical  Press 
and  Circular,  October  2,  1907,  so  that  favorable  results, 
have  now  been  recorded,  though  without  comment,  by 
the  two  bitterest  opponents  of  the  treatment  in  the  medical 
press  in  this  country.  The  doctor  says,  "Without  exag- 
geration, I  can  describe  the  results  as  marvelous."  After 
two  months'  treatm.ent  the  case  passed  into  other  hands, 
Dr.  Matthew's  successor  having  "no  faith  in  trypsin." 
The  treatment  was  discontinued  and  the  man  died  six 
months  afterwards  of  "exhaustion,"  having  had  no  pain 
or  hemorrhage.  I  do  not  doubt  that  this  was  poisoning 
by  the  products  of  the  dead  tumor,  which  the  use  of 


250    THE  CONQUEST  OF  CANCER 

amylopsin  would  in  all  probability  have  averted.  In  this 
case  (cancer  of  the  tongue)  the  treatment,  until  its  dis- 
continuance, did  everything  that  could  be  asked  for,  nor 
were  there  any  local  troubles  at  the  site  of  injection — in 
fact,  nothing  but  the  best  results. 


CHAPTER  XVII 

THE  CLAIMS  OF  THE  TREATMENT 

It  has  been  part  of  the  method  of  our  opponents  to 
assert  that  I  have  declared  trypsin  to  be  an  infalHble  cure 
for  cancer,  always  annihilating  the  disease.  It  need 
hardly  be  said  that  references  are  never  given.  No  one 
has  at  any  time  made  such  claims,  and  those  I  make  for 
the  treatment  nov/,  after  the  experience  of  a  host  of  ob- 
servers during  nearly  three  years  in  all,  are,  if  anything, 
greater  than  I  have  anywhere  made,  or  any  one,  so  far  as 
I  know,  has  anywhere  made,  hitherto. 

That  trypsin  and  probably  various  other  ferments  have 
a  specific  toxic  action  upon  the  cells  of  malignant  tissue 
in  general,  whether  carcinomatous  or  sarcomatous,  is 
now  a  fact  repeatedly  proved,  as  to  the  specific  digestion 
both  of  dead  malignant  tissue  In  a  test-tube,  and  of  the 
living  tissue  in  its  site  of  growth ;  that  is  to  say,  both 
in  vitro  and  in  vivo.  This  has  been  repeatedly  proved  by 
independent  observers  of  the  highest  repute  in  Berlin 
alone  during  the  past  two  years ;  and,  as  a  fact,  is,  like 
other  facts,  independent  of  any  theory  whatsoever.  It 
'does  not  depend  upon,  nor  does  it  demonstrate  the  truth 
of,  the  trophoblastic  theory  of  cancer;  and  it  does  not 
prove  that  trypsin,  for  instance,  is  of  use  in  the  treatment 
of  the  disease,  since,  for  instance,  it  might  be  that  the 
products  of  its  action  upon  cancer  in  life  were  far  more 
deadly  than  the  cancer  itself.  It  is  merely  a  fact — ^that  a 
I  251 


S52     THE  CONQUEST  OF  CANCER 

ferment  or  ferments  are  known  which,  in  vivo  or  in  vitro, 
have  a  specific  digestive  action  upon  mahgnant  tissue. 
It  will  be  evident  to  the  scientific  reader  that  the  indica- 
tion of  this  by  Dr.  Beard,  on  December  13,  1904,  was  an 
epoch  in  the  study  of  the  disease,  whether  his  trophoblast 
theory  be  right  or  wrong,  and  whether  or  not  we  of  the 
present  generation  can  turn  the  cancrotoxic  ferments  to 
practical  account.  No  one  will  question  that,  if  all  the 
rest  does  not  now  follow,  it  will  follow.  The  enemy's 
weak  point  has  at  last  been  found,  and  if  we  do  not  strike 
home,  our  descendants  will.  The  conquest  of  cancer 
must  be,  at  the  very  least,  within  hailing  distance,  the 
naturally  appointed  weapons  being  at  last  in  our  hands. 

But,  as  every  one  knows,  more  is  claimed  than  this,  and 
I  only  insist  upon  it  as  a  demonstrated  fact — which,  so 
far  as  the  test-tube  experiment,  at  any  rate,  is  concerned, 
any  one  may  prove  for  himself — because  in  Great  Britain 
the  fact  is  not  yet  admitted,  the  foreign  evidence  having 
been  ignored,  and  the  official  native  observers  having 
failed  and  having  loudly  advertised,  with  the  aid  of  royal 
lips,  their  failure  to  record  it ;  forgetful  that  in  any  scien- 
tific experiment  failure  only  proves  that  the  particular 
observer  has  failed. 

I  have  more  to  say,  however,  than  that  we  have  at 
last  found  the  right  road  to  our  goal,  and  the  present 
question  is  as  to  what  Dr.  Beard's  discovery  is  worth  to 
us  to-day. 

In  passing,  I  claim  what  no  one  will  dispute,  and  what 
was  known,  though  not  acted  upon,  even  before  Dr. 
Beard  began  his  researches  twenty  years  ago.  It  is  that 
trypsin,  the  most  powerful  of  all  known  proteolytic  fer- 
ments, can  digest,  at  the  temperature  of  the  body,  many 
forms  of  dead  proteid  tissue  of  animal  origin.     On  this 


THE  CLAIMS  OF  THE  TREATMENT    253 

unquestioned  ground  I  commend  its  local  application  in 
all  cases  where  a  cancer  or  other  malignant  tumor  is  ex- 
posed to  the  air,  and  undergoing  necrosis  or  local  death 
upon  its  surface.  Properly  applied  in  such  cases,  trypsin 
will  invariably  keep  the  surface  perfectly  clean,  affording 
bacteria  no  dead  material  on  which  to  grow.  In  conse- 
quence it  will  effect  what  any  agent  would  effect  by  such 
action :  it  will  abolish  all  malodorousness,  such  as  is  the 
curse  of  most  advanced  cancer  cases,  and  it  will  prevent 
that  absorption  of  bacterial  poisons  to  which,  in  part,  at 
least,  the  constitutional  poisoning,  or  so-called  "cachexia," 
of  cancer  is  due,  together  with  the  loss  of  weight  which 
is  its  consequence.  Familiar  examples  are  cancer  of  the 
mouth,  cancer  of  the  uterus,  and  exposed  cancer  of  the 
breast.  I  ask  the  surgeons,  believing  nothing  whatever 
in  this  book  except  that  trypsin  is  a  proteolytic  ferment* 
and  probably  the  most  powerful  of  its  kind — certainly  the 
most  powerful  of  animal  origin — to  employ  it  for  this 
purpose.  Let  them  use  it  solely  as  a  local  wash,  and  I 
predict  that,  having  abolished  the  patient's  cachexia  and 
the  fcetor  of  the  disease,  they  will  find  reason  to  apply  it 
also  remedially,  in  the  full  sense.  The  local  application 
alone  cannot  be  remedial,  except  possibly  in  superficial 
cases  of  rodent  ulcer  without  secondary  growths.  For 
this  method,  the  use  of  which  alone  would  constitute  a 
great  advance  in  the  treatment  of  cancer,  I  claim  further 
a  specific  advantage  over  the  employment  of  iodoform, 
formalin,  carbolic  acid  or  other  antiseptics.  This  is  that, 
according  to  Von  Leyden's  law,  these  agents,  in  so  far 
as  they  reach  the  living  cells  of  the  growth,  stimulate  such 
as  they  do  not  actually  kill ;  while  trypsin,  as  he  has  shown, 
is  unique  among  chemical  agents,  and  resembles  ethereal 
radiations  of  short-wave  length,   such  as  the  Rontgen 


254-  THE  CONQUEST  OF  CANCER 

rays,  and  the  ethereal  radiations  of  radio-active  sub- 
stances, in  that  it  causes  no  increased  growth  and  no 
enhanced  mahgnancy  in  the  tumor.  I  further  ask  the 
countless  surgeons  and  others  who  have  hitherto  de- 
clined to  employ  trypsin  for  this  purpose,  on  what 
grounds  they  have  so  declined?  Do  they  deny  that 
trypsin  can  digest  dead  proteid  tissue,  or  are  they  per- 
fectly satisfied  with  their  present  methods  of  dealing  with 
the  smell  and  the  bacterial  poisoning  of  exposed  cancer, 
or  do  they  attribute  to  the  local  use  of  trypsin  some  dan- 
gers of  its  own  ?     Or  are  there  graver  explanations  ? 

I  claim,  in  proceeding,  that  the  new  treatment,  prop- 
erly applied,  is  absolutely  free  from  all  danger,  and  in  this 
respect  I  claim  for  it  a  unique  place  in  comparison  with 
surgical  operation,  the  use  of  caustics  or  the  Rontgen 
rays  or  radio-active  substances.  It  has  been  clearly 
shown — what  scarcely  needed  showing — that  trypsin,  a 
normal  inhabitant  of  the  body,  produces,  even  in  enor- 
mous doses,  no  symptoms  whatever  but  increase  of  weight 
in  healthy  animals,  healthy  human  beings,  or  patients 
suffering  from  innocent  tumors. 

The  injections  may  be  so  made  as  to  cause  abscesses. 
In  not  far  short  of  two  years  I  have  never  seen  this 
result,  and  some  individual  workers  have  given  as  many 
as  a  thousand  injections  without  once  obtaining  it.  The 
accident  may  befall  any  one,  but  he  to  whom  it  occurs 
frequently  is  not  suited  for  the  practice  of  medicine,  and 
him  only  would  I  warn  against  the  treatment. 

There  are  remoter  and  less  inexcusable  possibilities, 
however.  Drs.  Pinkuss  and  Pinkus  have  shown,  in  their 
paper  in  Medizinische  Klinik,  that  injections  made  delib- 
erately in  animals,  from  pancreas-glands  that  were  not 
fresh,  caused  symptoms  of  serious  poisoning.     I  here  as- 


THE  CLAIMS  OF  THE  TREATMENT    255 

sume  that  the  injections  are  made  as  described  in  the 
chapter  devoted  to  that  subject. 

Even  then,  in  cancerous  patients,  and  in  them  alone, 
injections  made  in  cleanly  fashion  may  cause  constitu- 
tional symptoms.  I  note  in  passing  that  these  are  an 
index  and  proof  of  the  action  of  the  remedy  upon  the 
disease.  They  may  be  met  by  the  use  of  amylopsin,  the 
adjuvant  value  of  which  is  attested  by  observers  both  in 
America  and  Germany — and  now  even  in  Great  Britain. 
No  case  has  been  reported  in  which  the  new  treatment, 
properly  applied,  without  abscess  formation,  has  proved 
dangerous  or  even  injurious  to  the  patient.  It  need  hardly 
be  said  that,  if  patients  were  occasionally  killed  by  it, 
the  treatment  would  be  condemned  by  all  and  not  least 
by  the  surgeons,  though  patients  unfortunately  die  every 
day  from,  and  under,  operations  for  cancer.  To  a  new 
treatment  canons  are  applied  which  no  one  dreams  of 
applying  to  an  established  treatment.  But  in  respect  of 
risk  to  life  no  credible  treatment  of  cancer  hitherto  pro- 
posed can  vie  with  the  pancreatic  treatment. 

I  claim  that,  in  addition  to  removing  all  foetor  and 
preventing  bacterial  intoxication  or  cachexia  otherwise 
caused,  the  new  treatment  is  a  specific  for  the  pain  of 
cancer.  I  have  never  seen  morphine  injected,  or  asked, 
for,  or  required  by  patients  undergoing  the  pancreatic 
treatment.  Without  any  of  the  grave  and  obvious  disad- 
vantages of  inorphine,  it  accomplishes  in  this  respect  all 
that  morphine  ever  accomplishes,  and  habitually  succeeds 
where  morphine  fails.  There  is  no  longer  any  need  for 
any  cancerous  patient  to  become  a  morphino-maniac. 
Says  Dr.  Cleaves  (N.  Y.  Medical  Record,  June  i,  1907)  : 
"The  indications  are  that  the  use  of  the  enzyme  (fer- 
ment)  treatment  will  have  to  be  continued  over  long 


^56  THE  CONQUEST  OF  CANCER 

periods  of  time  and  perhaps  at  intervals  throughout  life, 
but  as  the  absence  of  pain  is  a  constant  accompaniment, 
it  would  seem  logical  and  better  to  have  a  patient  with 
the  trypsin  necessity  rather  than  the  morphine  habit." 
This  is  the  evidence  of  nearly  a  year's  experience  with 
several  cases.  Prof.  Morton,  after  eight  months'  experi- 
ence in  twenty-nine  cases,  reported :  "Relief  of  pain  in 
all  cases";  and  cancer,  as  I  have  known  it  since  Febru- 
ary, 1906,  is  a  disease  in  which  (cancerous)  pain — like 
foetor — does  not  occur.  Dr.  Pinkuss  in  Germany  and 
Drs.  Meggitt  and  Cavanagh  at  home  have  lately  reported 
similarly. 

We  know  the  influence  of  the  mind  over  the  body,  we 
know  that  violet  leaves  may  abolish  the  pain  of  cancer — 
or  Christian  Science,  or  injections  of  salt  and  water  called 
morphine.  The  reader  may  assume  that  the  relief  of 
pain  by  trypsin  is  of  this  order.  From  the  first  I  have 
assumed  that  the  critics  would  so  assume,  and  therefore 
I  have  directed  little  attention  to  the  fact,  beneficent  and 
constant  though  it  be — in  my  experience  and  that  of 
many  others.  The  skeptic  is  welcome  to  make  the  same 
assumption  still ;  only  I  ask  him,  when  and  if  other  means 
fail  to  relieve  pain,  to  try  trypsin.  He  will  not  go  back 
to  morphine.  In  short,  there  is  claimed  for  trypsin, 
properly  used,  the  supersession  of  morphine  and  other 
analgesics  in  the  treatment  of  cancer  at  all  stages.  A 
theory  of  its  action  is  not  essential  and  may  be  prema- 
ture; we  do  not  cease  to  employ  morphine  because  its 
action  cannot  be  explained;  but  the  remarkable  consist- 
ency of  the  result,  whatever  the  facts  of  the  case  in  ques- 
tion, and  the  success  of  trypsin  in  abolishing  pain  and 
permitting  sleep,  even  where  the  largest  possible  doses 
,of  morphine  fail,  make  it  probable,  I  think,  that  the  action 


THE  CLAIMS  OF  THE  TREATMENT,    257 

is  not  an  anaesthetic  one,  either  by  the  direct  action  of  the 
ferment  on  the  sensorium  or  the  nerve-endings,  or  by  the 
action  of  its  digestive  products ;  but  is  due  to  its  arrest 
of  the  growth  of  the  tumor  at  its  margins,  and  to  the 
lowering  of  its  pressure  by  reduction  of  its  density.  It 
is  generally  recognized  that  the  pain  of  cancer,  Hke  its 
constitutional  poisoning,  and  indeed  its  symptoms  in  gen- 
eral, is,  so  to  speak,  accidental.  The  tumor  is  not  sup- 
posed to  secrete  substances  which  irritate  the  nerve-ends, 
but  is  supposed  to  cause  pain  solely  by  pressure.  There 
are,  of  course,  no  nerves  or  nervous  elements  evolved  in 
any  malignant  tumor.  Pain  is  not  an  early  symptom  of 
cancer,  and  many  fatal  cancers  are  painless  throughout. 

It  is  claimed  for  the  treatment,  then,  that  it  is  an  unap- 
proached,  constant,  and  wholly  effective  remedy  for  the 
pain  of  cancer.  I  do  not  for  a  moment  believe  that  it 
would  have  any  effect — except  through  the  mind — upon 
any  other  pain;  and  if  any  one  asserts  that  its  action  in 
cancer  is  through  the  mind  I  will  not  concern  myself  to 
contradict  him.  In  fact,  I  will  assent,  if  the  assent  will 
encourage  him  to  make  promises  to  the  patient,  and  so 
utilize  his  mind  as  far  as  possible.  I  do  not  assert  how 
it  acts,  but  simply  that  it  does  act. 

Though  the  relief  of  pain  has  hitherto  been  observed 
by  every  one  who  has  made  competent  trial  of  the  new 
method,  though  I  have  never  seen  it  fail  in  this  respect, 
and  though  even  Prof,  Bier,  employing  ferments  by  means 
of  the  injection  of  blood,  obtained  the  same  result  in 
nearly  all  cases,  it  is,  of  course,  possible  that  a  nerve 
may  become  involved  in  a  growth,  without  being  de- 
stroyed, in  such  a  fashion  that  even  the  instantaneous 
death  of  the  growth  would  not  relieve  pain ;  and  it  is  even 
conceivable  that,  in  the  course  of  its  shrinkage  or  replace- 


258  THE  CONQUEST  OF  CANCER 

ment  by  fibrous  tissue,  a  tumor  might  press  upon  an 
undestroyed  nerve  even  more  painfully  than  before.  In 
such  cases  the  treatment  would  fail  to  relieve  pain,  and 
pain  might  conceivably  become  an  increasingly  promi- 
nent symptom  for  some  time,  even  during  the  actual  cure 
of  the  disease.  These  possibilities  must  be  remembered, 
though  at  the  present  time  they  remain  possibilities  only. 
In  such  cases  it  is  quite  conceivable  that  morphine  would 
succeed  where  trypsin  failed  to  relieve  pain,  though  pos- 
sibly curing  or  arresting  the  disease. 

The  discovery  of  a  remedy  which  prevents,  abolishes, 
or,  at  the  very  least,  arrests  the  progressive  cachexia  of 
cancer,  abolishes  the  smell  of  exposed  cancers,  and  re- 
lieves the  pain  of  all  cancers,  without  risk  and  without 
stimulation  of  the  growth,  would  abundantly  warrant  us 
in  giving  it  the  earliest  and  widest  publicity ;  but  much 
more  is  claimed,  though  I  submit  that  these  claims  alone 
should  insure  for  it  the  widest  trial,  and  that  more — if 
more  there  be — might  then  be  allowed  to  appear  for  it- 
self. 

It  is  not  claimed  for  this  remedy,  nor  has  it  ever  been 
claimed  by  Dr.  Beard  or  myself,  nor  can  it  ever  be  war- 
rantably  claimed  for  any  remedy  yet  in  the  womb  of  Time, 
that  it  will  keep  alive  indefinitely  any  and  every  cancerous 
patient.  In  a  large  proportion  of  the  cases  under  trial 
hitherto,  the  patient  was  already,  on  coming  under  treat- 
ment, a  broken  or  even  a  moribund  man,  worn  out  and 
dismembered  by  repeated  operations.^  These  had  greatly 
enhanced  the  malignancy  of  the  growth,  according  to  the 
general  rule  of  the  irritation  of  cancer  by  the  knife  or 
other  agents.     Already  the  disease  and  the  knife  had 

^Many  patients  have  died  before  the  preparations  could  even 
reach  the  hands  of  the  physician. 


THE  CLABIS  OF  THE  TREATMENT    2591 

attacked  and  destroyed  various  tissues  and  organs,' blood-^ 
vessels,  nerves  necessary  to  local  health,  and  so  forth.  No 
human  or  natural  power,  nothing  but  a  supernatural  in- 
terference, could  restore  what  had  thus  or  otherwise  been 
destroyed.  Cut  the  skin  to-day,  and  though  it  heals  to- 
morrow, certain  glands  and  cells  characteristic  of  skin 
have  been  destroyed  once  and  forever.  Trypsin  has 
added  months  to  the  lives  of  such  patients ;  it  may  in  some 
cases  have  averted  death  indefinitely;  but  it  cannot  alter 
the  past.  It  cannot  re-create  destroyed  structures,  it  can- 
not restore  a  ruined  constitution,  it  cannot  replace  by 
healthy  kidneys  those  already  poisoned  by  the  passage 
through  them,  for  months  or  years,  of  bacterial  poisons. 

To  this  the  reader  may  reply  that  no  one  but  a  fool 
would  expect  trypsin  to  work  miracles.  This  I  grant,  and 
thank  him  for  the  word;  for  now  we  know  how  to  de- 
scribe those  who  have  demanded  that  trypsin  shall  per- 
form these  miracles  and  perform  them  every  time,  and 
who,  with  joy  shamelessly  unconcealed,  have  hailed  as 
demonstration  of  its  worthlessness  the  deaths  of  such  pa- 
tients, without  asking  whether  life  was  not  prolonged  or 
whether  the  patients'  latter  days  were  not  incalculably 
ameliorated  by  the  treatment. 

The  pathological  evidence  elsewhere  cited  strongly  sug- 
gests that  it  would  be  well  to  make  no  claims  whatever — 
except  as  to  the  relatively  minor  matters  already  discussed 
— for  the  pancreatic  ferments  in  cases  where  the  ma- 
lignancy of  the  disease  has  been  indefinitely  increased,  not 
to  mention  the  mutilation  of  parts,  by  surgical  operation, 
and  especially  by  repeated  operation.  Here,  again,  a 
grossly  unfair  and  ilbgical  criterion  is  applied.  The  test 
case  for  surgery  shall  be  the  earliest  possible  case,  chosen 
ty  the  surgeon,  and  free  from  secondary  growths.    The 


iS60  THE  CONQUEST  OF  CANCER 

"test  case  for  trypsin  shall  be  this  same  case,  chosen  by 
the  surgeon  again,  months  or  years  later,  after  one  or 
many  surgical  failures,  when  the  liver  and  other  internal 
organs  are  affected  by  secondary  growths,  and  the  pa- 
tient's excretory  and  digestive  organs  are  irremediably 
ruined  by  bacterial  poisoning. 

This  is  not  the  fault  of  the  surgeons,  but  of  human  na- 
ture. If  trypsin  were  the  orthodox  remedy  for  cancer, 
and  some  one  proposed  the  knife,  the  orthodox  would 
hand  over  their  moribund  cases,  if  such  there  were,  to 
the  innovator,  and  condemn  him  because  he  could  not 
save  every  one  without  exception.  I  have  seen  trypsin 
perform  most  things  short  of  a  miracle,  but  no  miracles 
yet.     It  is  not  a  creator;  but  is  the  knife? 

Let  us  revert  for  a  moment  to  the  theory.  As  Dr. 
Beard  has  put  it  to  me,  when  nature  kills  and  digests  nor- 
mal trophoblast — the  "syncytium"  or  mantle-tissue  of  the 
chorion — in  normal  pregnancy,  by  means,  as  he  asserts,  of 
the  trypsin  produced  by  the  foetal  pancreas,  she  has  only 
given  it  a  seven  weeks'  start;  and  no  surgical  operations 
have  previously  been  performed,  heightening  its  malig- 
nancy— for  undoubtedly  it  is  a  malignant  tissue,  so  long 
as  it  lives,  in  its  action  on  the  wall  of  the  womb.  Now 
nature  never  fails  in  this  respect,  provided  that  the  foetal 
pancreas  has  due  opportunities  for  action.  Otherwise, 
as  we  know,  chorio-epithelioma,  or  "trophoblastoma,"  as 
it  should  be  called,  is  apt  to  develop ;  perhaps  it  invariably 
"develops  if  the  foetal  pancreas,  say  before  a  miscarriage, 
has  not  already  killed  it.  Now,  assuming  the  relevance 
of  these  facts  to  the  case  of  cancer  or  "irresponsible  tro- 
phoblast," we  may  argue  that  the  nearest  possible  repro- 
duction of  the  natural  conditions  would  be  the  use  of 
trypsin  in  early  cases,  unmodified  by  the  knife  or  by  caus- 


THE  CLAIMS  OF  THE  TREATMENT    261 

tics.  Whether  they  are  accessible  or  not  to  the  knife  or 
other  means,  they  are  never  inaccessible  to  the  blood, 
which  will  convey  the  ferment  to  them. 

It  is  not  claimed,  then,  that  trypsin  will  cure  outright 
all  such  cases  as  the  surgeons,  after  one  or  more  opera- 
tions, have  abandoned.  I  certainly  believe  that  the  fer- 
ment treatment  should  be  employed  in  such  cases,  as  in 
all  cases,  and  that  it  will  prolong  life,  relieve  pain,  abol- 
ish foetor,  and  at  least  retard  the  disease.  It  may  even 
kill  the  tumor  outright,  but  fail  to  save  the  patient,  who 
dies  as  the  gradual  consequence  of  all  that  he  has  previ- 
ously undergone.  As  for  the  critic  who  argues  that  if 
trypsin  cannot  save  these  patients  it  is  condemned,  and 
that  there  is  no  treatment  for  cancer  but  the  knife — I  will 
waste  no  further  words  upon  him. 

But,  quite  apart  from  the  factitious  enhancement  of 
the  malignancy  of  a  growth  by  the  knife  or  caustics,  or 
the  use  of  antiseptics,  we  have  to  recognize  that  different 
tumors  vary  widely  in  their  degree  of  malignanc}^,  though 
all  may  be  unmistakably  malignant.  The  causes  of  these 
differences  have  been  practically  or  wholly  unexamined 
hitherto.  The  pathologists,  unaware  that  the  problem  of 
cancer  is  a  chemical  one,  have  confined  themselves  to  the 
association  of  certain  microscopic  characters  with  this  or, 
that  degree  of  malignancy. 

But  a  moment's  thought  shows  that  the  shapes  of  cells 
are  not  the  cardinal  matter  here.  The  malignancy  of  any 
tumor  is  determined,  I  submit,  by  the  ratio  between  the 
amount  and  potency  of  the  ferment  produced  by  it  on 
the  one  hand,  and  the  amount  and  potency  of  the  anti- 
dotal substances  of  the  blood  and  normal  tissues  on  the 
other  hand.  Thus  it  is  a  common  experience  to  find  the 
malignancy  of  a  tumor  reduced,  and  its  growth  retarded, 


S62    THE  CONQUEST  OF  CANCER 

by  the  administration  of  the  antidotal  substance,  trypsin, 
which  alters  this  ratio  in  favor  of  the  host  as  against  the 
parasite. 

But  in  general,  it  may  be  argued,  I  believe,  that  the 
dominating  factor  in  this  ratio  is  the  factor  of  the  cancer 
ferment  or  ferments ;  and  an  argument  in  favor  of  this 
supposition  is  the  fact  that  operation,  caustics,  etc.,  so 
constantly  enhance  the  malignancy  of  a  tumor  (which 
alters  meanwhile  in  microscopic  structure).  In  such 
cases  the  patient's  body  is  approximately  the  same ;  it  is 
the  ttmior  that  has  been  modified. 

Hence,  on  the  whole,  the  malignancy  of  a  tumor  de- 
pends on  the  amount  and  potency  of  the  ferment  or  fer- 
ments produced  by  it.  Eugen  Petry,  in  1899,  identified 
a  cancer-ferment,  which  Dr.  Beard  has  named  "malig- 
nin."  That  such  a  ferment  exists  is  a  matter  not  of  ob- 
servation but  of  obvious  necessity.  But  there  is  no  war- 
rant for  asserting  that  there  is  only  one  cancer-ferment. 
There  may  be,  for  instance,  almost  as  many  as  there  are 
different  degrees  of  malignancy.  Is  it  not  more  than 
probable  that  the  ferment  produced  by  a  scirrhus  of  the 
breast,  which  lasts  for  twenty  years,  is  very  different  from 
the  ferment  of  a  melano-sarcoma  which  kills  in  as  many 
weeks  ?  The  difference  may  well  be  as  great  as,  or  greater 
than,  the  difference  between  the  digestive  potency  of 
trypsin  or  amylopsin  on  the  one  hand,  and  pepsin  or  the 
ptyalin  of  the  saliva  on  the  other  hand. 

It  is  quite  conceiA^able  that,  for  instance,  certain  highly 
malignant  sarcomas  may  produce  ferments  which  trypsin 
cannot  neutralize,  but  which  actually  digest  it.  There 
is  already  evidence  to  show  that  in  such  cases  much  larger 
doses  of  trypsin  are  necessary  in  order  even  to  arrest,  let 
alone  kill,  the  tumor.     There  may  be  cases  which,  from 


THE  CLAIMS  OF  THE  TREATMENT    263 

the  first,  unmodified  by  the  knife  or  by  caustics,  are  in- 
capable of  arrest  by  tr\-psin.  It  is,  therefore,  not  claimed 
— at  present,  at  any  rate — that,  even  in  the  most  favorable 
circumstances,  trypsin  would  cure  all  cases  of  malignant 
disease.  But  the  ferments  of  cancer-cells  are  intracellular, 
and  it  is  scarcely  possible  to  imagine  that  any  intracellular 
ferment  can,  during  life,  be  as  potent  as  the  extracellular 
trypsin. 

On  the  other  hand,  writing  now  at  the  beginning  of 
this  subject,  and  not  under  the  delusion  that  we  are  at  the 
end  of  it,  I  certainly  do  not  assert  that  we  are  in  pos- 
session of  evidence  which  demonstrates  the  incurableness 
from  the  first  of  certain  forms  of  tumor  by  trypsin.  So 
far  as  I  am  aware,  the  pancreatic  treatment  has  not  yet 
been  employed  in  cases  of  melano-sarcoma  or  chorio- 
epithelioma.  It  has  been  employed,  however,  in  many 
cases  of  sarcoma,  and  the  reader  may  be  referred  to  the 
case  treated  by  Dr.  Doran  (.Y.  F.  Medical  Record,  July 
6,  1907).  Enormous  dififerences  have  been  observed  be- 
tween the  results  of  treatment;  but  until  the  preparations 
are  standardized  we  have  no  right  to  assume  any  other 
explanation  than  that  which  has  undoubtedly  been  the 
correct  one  in  most,  if  not  in  all  cases,  hitherto.  We 
may  note  that  relatively  non-malignant  growths  have  re- 
sponded little  to  the  treatment  in  some  cases,  while  viru- 
lent sarcomas  have  yielded  in  others.  In  some,  at  any 
rate,  of  the  cases  to  which  I  refer,  absolutely  worthless 
preparations  were  employed.  Thus  I  neither  assert  nor 
deny  that  there  are  primary  cases  of  malignant  disease 
in  which  trypsin  is  impotent  to  destroy  living  cells — 
though  it  will  always  dispose  of  the  products  of  super- 
ficial necrosis.  The  German  observers,  Schiitze,  Eergell, 
Pinkuss,  and  Pinkus,  have  shown  that  no  anti-trypsin  is 


264^  THE  CONQUEST  OF  CANCER 

formed  by  the  healthy  body  when  trypsin  is  formed 
into  the  blood.  But  I  regard  it  as  a  possibility, 
if  no  more,  that  when  trypsin  is  brought  into  action 
against  cancer,  the  cancerous  cells  may  produce  an  anti- 
trypsin. Indeed,  on  general  principles,  this  is  perhaps 
more  likely  than  not.  The  blood  of  patients  under  the 
treatment  should  be  examined  in  this  regard.  The  very 
principles  which  make  intelligible  the  absence  of  anti- 
trypsin formation  in  the  healthy  body,  and  the  develop- 
ment of  anti-bodies  to  foreign  ferments,  would  also  make 
intelligible  the  development  of  an  anti-body  by  cancer 
when  attacked  by  what  is  to  it  a  foreign  ferment  and  a 
dangerous  one.  This,  of  course,  is  only  speculation,  so 
far,  but  I  think  it  is  reasonable  speculation,  and  may  be 
useful. 

In  the  absence,  hitherto,  of  positive  evidence  on  this 
point,  I  am  much  inclined  not  merely  to  regard  with  a 
new  interpretation  the  cases  where  absurd  doses  of  tryp- 
sin— two  per  cent,  solutions  and  the  like — have  been  em- 
ployed, but  also  to  question  the  propriety  of  starting  the 
treatment,  or  any  form  of  ferment  treatment,  with  minute 
and  gradually  increased  doses,  as  if  one  were  attempting 
to  establish  artificial  immunity  in  a  case  of  hydrophobia. 
The  question  arises,  I  think,  whether  this  may  not  be  pre- 
cisely the  fashion  in  which  one  would  proceed  if  it  were 
being  attempted  to  establish  immunity  on  the  part  of  the 
tumor.  I  believe  that  I  have  seen  indications  which 
strongly  suggest  that  this  establishment  of  immunity  may 
occur;  and  if  I,  myself,  were  to  undergo  the  treatment, 
I  should .  prefer  to  start  with  very  large  doses,  in  the 
expectation  that  the  object  to  be  aimed  at  was  the  death 
of  the  tumor  before  it  had  had  time  to  establish  immu- 
nity— assuming  such  to  be  possible.    This  is  how  the  bac- 


iTHE  CLAIMS  OF  THE  TREATMENT    265 

teria  of  disease  actually  kill.  They  pour  such  a  dose  of 
their  ferments  or  toxins  into  the  blood  that  death  occurs 
before  immunity  can  be  established.  If  any  device  can 
keep  the  pneumonic  patient  alive  till  the  tenth  day,  rather 
than  the  sixth,  he  will  probably  recover;  the  object  is  to 
tide  him  over  the  crisis — i.e.,  to  keep  him  alive  until  he 
can  immunize  himself.  It  may  be  suggested  that  in  the 
attempt  to  kill  a  cancer  we  should  adopt  the  methods  only 
too  successfully  employed  by  the  microbes  of  disease — 
make  the  initial  doses  so  large  that  the  subject  has  no 
time  to  defend  himself. 

My  personal  observation  has  chiefly  been  concerned 
with  Messrs.  Squire's  preparations,  which  are  very  rich  in 
amylopsin ;  and  the  precautions  as  to  initial  dosage,  much 
insisted  upon  by  some  workers,  are  irrelevant  with  these, 
and  presumably  with  any  in  which  sufficient  amylopsin  is 
contained.  A  first  dose  of  i  c.c.  of  the  Standard  ii,  con- 
taining 5CXD  units  of  tryptic  and  200  of  amylolytic  activity, 
is  perfectly  well  borne ;  and  if  the  line  of  argument  here 
submitted  should  prove  to  be  valid,  it  is  evident  that  such 
doses,  or,  indeed,  the  largest  compatible  with  safety, 
should  be  given  from  the  first.  I  doubt  whether,  in  the 
presence  of  sufficient  amylopsin,  there  is  any  upper  limit 
of  safety,  especially  if  the  kidneys  be  sound. 

Further,  if  the  above  argument  be  valid,  it  must  be 
found  that  some  patients  do  well  for  a  time  and  then  cease 
to  advance,  or  even  go  back.  Assuming  such  cases  to 
occur,  and  other  explanations  failing,  I  would  incline  to 
the  view  that  the  growth  has  become  immunized  to  the 
ferments,  and  is  recovering,  just  as  the  pneumonia  or 
influenza  or  typhoid  patient  recovers.  Such  cases  must 
be  prevented  from  occurring,  if  possible,  by  vigorous  in- 
itial treatment ;  but  if  they  do  occur,  plainly  the  doses  of 


266  THE  CONQUEST  OF  CANCER 

the  ferments  must  be  greatly  increased.  Perhaps  the 
difference  between  advanced  recurrent  cases  and  early 
unoperated  ones,  in  respect  to  ferment  treatment,  may  be 
reduced  to  some  such  terms  as  will  readily  suggest  them- 
selves to  the  reader  who  finds  the  present  argument  ra- 
tional. 

Practically  the  only  specific  remedies  known  to  medical 
science  hitherto  are  mercury  for  syphilis,  quinine  for  ma- 
laria, and  the  antitoxin  of  Behring  and  Roux  for  diph- 
theria. It  is  stated,  and  truly,  in  general  terms,  that  mer- 
cury cures  syphilis  and  quinine  malaria ;  but  there  are 
cases  of  syphilis  which  mercury  does  not,  and  apparently 
cannot,  cure ;  and  exactly  the  same  is  true  of  quinine  in 
malaria.  I  believe  it  will  be  admitted  before  long  that, 
in  the  same  sense  as  that  in  which  quinine  is  said  to  cure 
malaria,  trypsin  and  amylopsin  cure  cancer,  in  certain 
cases,  at  any  rate. 

The  incredible  argument  has  been  adduced  by  some 
critics,  presumably  adult,  such  as  the  editorial  writer  in 
the  British  Medical  Journal,  and  even  a  writer  in  Nature, 
that  it  is  improper  to  speak  of  a  cure  of  any  case  of  cancer 
until  three  years  have  elapsed  without  recurrence.  I  need 
hardly  say  that  the  three  years'  limit  is  not  a  law  of  na- 
ture, and  that  no  possible  parallel  exists  between  the  de- 
generation and  disappearance  of  a  growth  by  means  of 
agents  carried  in  the  blood  and  the  removal  of  it  by  the 
knife — in  which  latter  case  the  portions  almost  invariably 
left  behind  usually  show  their  presence  within  three  years. 

It  is  claimed  for  the  treatment  that  it  is  appHcable  to, 
and  should  be  employed  in,  all  cases  of  malignant  disease,, 
without  exception,  whether  early  or  late,  carcinomatous, 
sarcomatous,  or  other,  operable  or  inoperable,  operated 
upon  or  not  .operated  upon,  accessible  or  inaccessible,  sin- 


THE  CLAB^IS  OF  THE  TREATMENT    267 

gle  or  multiple,  primary  or  recurrent,  with  or  without 
secondary  growths,  painful  or  painless,  dubious  or  cer- 
tain. A  large  proportion  of  my  correspondence  since 
March,  1906,  has  consisted  of  letters  asking  whether  the 
treatment  is  applicable  to  such  and  such  a  kind  of  case. 
It  is  more  generally  applicable  than  mercury  in  syphilis, 
or  quinine  in  malaria.  I  know  of  no  contra-indication  to 
its  use,  and  no  ease — or  likelihood,  or  even  possibility — 
of  idiosyncrasy  to  this  substance  which,  be  it  remembered, 
is  a  normal  product  and  inhabitant  of  the  body,  and  has 
no  action  of  any  kind  upon  the  tissues  proper  to  the 
body. 

I  can  scarcely  do  better  here  than  quote  from  the  highly 
judicial  paper  of  Dr.  Cleaves  (A^".  Y.  Medical  Record, 
June  I,  1907),  with  the  note  that  I  am  far  from  convinced 
of  the  truth  of  the  view  that  the  treatment,  properly 
applied,  may  shorten  life.  Certainly,  Dr.  Cleaves  herself 
has  not  obtained  results  pointing  in  this  direction,  but 
I  believe  that  she  has  noted  them  in  other  (improperly 
treated)  cases. 

The  question  of  the  constitutional  symptoms  following 
the  use  of  trypsin  in  cancer  has  already  been  discussed. 
Dr.  Cleaves  says  : — 

"Conclusion. — The  justification  of  this  treatment  is  to 
be  found  in  (i)  the  pathological  findings,  (2)  relief  from 
pain,  (3)  absence  of  odor  and  necrotic  discharge,  (4)  im- 
proved metabolism,  (a)  in  cases  that  do  well,  (b)  even 
in  those  who  succumb,  (5)  increased  mental  vigor,  and 
(6)  by  inspiring  the  patient  with  hope. 

"On  the  other  hand,  it  may  result  in  shortening  life  by 
a  few  months,  but  that  short  span  of  added  existence 
would  be  characterized  by  breaking  down  of  tissues,  odor, 
necrotic  discharge,  pain,  imperfect  metabolism,  loss  of 


268     THE  CONQUEST  OF  CANCER 

mental  vigor,  and  by  utter  hopelessness  on  the  part  of 
patient  and  friends. 

"Treatment  should  be  undertaken  early  in  every  in- 
stance, and  should  always  be  an  adjunct  to  surgical  inter- 
ference in  every  post-operative  case." 

The  success  and  expectations  of  the  treatment  are  not 
fundamentally  affected  by  the  site  of  the  tumor,  nor  by 
the  existence  of  secondary  growths :  in  this  respect  con- 
trasting with  surgery.  The  essential  part  of  the  treatment 
is  hypodermic  injection,  and  it  is  entirely  irrelevant  to 
success  whether  the  tumor  be  of  the  lip,  or  the  oesophagus, 
or  the  liver.  The  factors  of  position  which  determine 
the  success  or  failure,  the  applicability  or  inapplicability, 
of  surgery,  are  not  relevant  here.  I  do  not  say  or  suggest 
that  all  tumors  are  alike  to  trypsin,  but  that  the  site  of  a 
tumor  and  the  existence  of  secondar}^  growths  are  not 
primary  considerations  in  this  connection. 

That  it  is  easier  to  kill  a  small  tumor  than  a  large  one, 
there  can  be  little  doubt;  but  every  part  of  the  larger 
tumor  must  be  directly  or  indirectly  accessible  to  the  blood 
if  it  is  to  live  at  all — and  therefore  to  trypsin.  The  factor 
of  malignancy — that  is  to  say,  as  I  suppose,  of  the  potency 
of  the  malignant  ferment — is  the  prime  factor  here,  not 
site  or  size.  This  is  not  to  say  that  it  is  not  a  much  length- 
ier process  to  dispose  of  the  degeneration-products  of 
a  large  tumor  than  of  a  small  one,  or  that  the  problem 
of  protecting  the  patient,  by  means  of  amylopsin,  from 
these  products  is  not  much  more  pressing  in  the  case  of 
a  larger  tumor.  It  is  to  be  supposed,  then,  that  early 
treatment  is  to  be  desired  not  so  much,  as  in  the  case  of 
surgery,  in  order  to  anticipate  the  formation  of  inacces- 
sible secondary  growths — all  cancer  cells  being  accessible 
to  the  blood,  or,  if  not,  bound  to  die  of  starvation  in  any^ 


THE  CLAIMS  OF  THE  TREATMENT    269 

case — ^but  in  order  to  avert  the  increase  of  malignancy 
which  usually  follows  surgical  interference,  and  because 
the  disposal  of  the  degeneration-products  of  a  tumor  will 
be  lengthy  and  difficult  in  direct  proportion  to  its  size. 

I  do  not  claim  for  this  treatment  that  it  can  be  carried 
out  by  any  practitioner :  in  this  respect  it  is  on  a  par  with 
antiseptic  surgery.  There  are  men  who  can  attend  to 
apparently  trivial  details,  and  men  who  cannot.  I  am 
convinced  that  the  status  of  the  new  method  would  be 
very  different  to-day  if  none  but  careful,  precise,  consci- 
entious and  assiduous  men  had  ever  undertaken  it. 

I  do  not  claim  for  the  treatment  that  it  is  cheap.  It 
is  cheap  compared  with  surgery — very  cheap;  and  per- 
haps the  question  of  results  is  relevant  here ;  but  it  is  pro- 
longed, and  the  injections  are  not  inexpensive,  though  I, 
for  one,  cannot  understand  how  it  is  possible  to  turn  them 
out  at  the  present  prices. 

I  do  not  claim  that  at  present  the  treatment  can  be 
carried  out  in  any  part  of  the  Southern  Hemisphere,  un- 
less very  special  precautions  as  to  the  traveling  of  the 
preparations  be  observed.  The  Southern  Hemisphere  will 
do  well  to  make  its  own  preparations. 

I  do  not  claim  that  the  materials  for  the  treatment  can 
be  obtained  anywhere.  In  my  first  articles  I  said,  being 
anxious  to  show  that  the  remedy  is  not  proprietary,  that 
trypsin  could  be  obtained  anywhere,  and  did  so  against 
the  advice  of  Dr.  Beard.  I  withdraw  that  statement  and, 
so  far  as  I  can  now  judge,  no  other  that  I  have  hitherto 
made  on  this  subject. 

Of  the  first  importance,  I  believe,  is  a  theoretical  objec- 
tion which,  though  long  present  to  my  mind  in  degree, 
has  only  lately  displayed  itself  to  me  in  its  full  force,  and 
which  must,  in  due  course,  be  recognized  in  practice.    At 


270     THE  CONQUEST  OF  CANCER 

the  meeting  in  1907  of  the  British  Association,  Prof.  H. 
E.  Armstrong  read  a  paper  on  "Enzymes,  their  Mode  of 
Action  and  Function,"  in  which,  after  observing  that  "the 
distinctive  feature  of  the  chemical  changes  going  on  in 
the  bodies  of  organisms  was  the  fact  that  they  are  under 
the  control  of  the  bodies  called  enzymes"  (Report  in 
Nature,  Sept.  26,  1907),  he  went  on  to  state,  as  "one  of 
the  outstanding  conclusions"  of  the  recent  study  of  en- 
zymes (or  ferments),  that  "all  chemical  equations  in- 
volving their  action  are  to  be  written  as  reversible 
changes."  This  obscure  but  momentous  question  of  the 
reversibility  of  ferments  is  still  in  its  very  beginnings.  I 
call  it  momentous,  since,  life  being  a  series  of  fermenta- 
tions, it  foreshadows  amazing  possibilities  as  to  turning 
backward  the  finger  of  time  for  living  creatures  generally 
— possibilities  so  stupendous  that  I  will  refrain  from  ex- 
pressing them  more  explicitly.  But  this  question  of  the 
reversibility  of  all  ferment  action  obviously  concerns  us 
as  regards  the  ferment  treatment  of  cancer;  and  it  may 
yet  be  found  that  our  highest  hopes  can  be  consistently 
realized  only  when  we  have  elucidated  and  can  control 
the  conditions  which  determine  the  direction  of  the  fer- 
ment action. 

With  these  considerations  before  me,  it  would  be  the 
merest  quackery  to  attempt  to  define  the  higher  claims  of 
the  treatment  without  reserve  or  qualification.  But  it 
must  surely  suffice  to  place  before  the  public  and  the  pro- 
fession the  evidence  which  proves  that,  at  any  rate,  results 
of  the  most  merciful  and  invaluable  kind  have  actually 
been  obtained,  and  are  now  being  obtained,  in  cases  far 
beyond  all  hope  from  the  knife  or  any  other  mode  of 
treatment  hitherto  practiced.  For  such  results  many  per- 
sons now  alive  are  deeply  indebted,  and  their  number 


THE  CLAIMS  OF  THE  TREATMENT    211 

can  be  indefinitely  increased  in  this  country  if  and  wKen 
my  solitary  but  soon  to  be  reinforced  voice  is  listened  to ; 
but  meanwhile  we  are  only  at  the  rude  beginnings,  and 
the  best  is  yet  to  be  :  "There  are  many  events  in  the  womb 
of  Time  which  will  be  delivered." 

I  do  not  claim  that  the  treatment  is  rapid.  Assuming 
the  relevance  of  the  facts,  we  may  note  that  Nature,  deal- 
ing with  trophoblast  of  only  seven  weeks'  development, 
and  without  surgical  operation,  takes  several  months  to 
dispose  of  it,  and  that  degenerate  remains  of  trophoblast 
can  be  observed  in  the  normal  placenta  at  full  term.  The 
present  estimates  of  length  of  the  treatment  may  some 
day  be  found  adequate — when  primary  and  untouched 
cases  come  under  a  perfected  method :  they  are  too  brief, 
much  too  brief,  when  applied  to  the  advanced  and  post- 
operative cases  which  for  some  time  to  come  will  furnish 
the  majority  of  cases.  In  more  cases  than  one  the  treat- 
ment has  been  stopped  prematurely  with  disastrous  re- 
sults. The  primary  growth  may  appear  to  be  dead,  but 
it  very  likely  has  been  accessible  to  local  application  as 
well  as  to  application  by  the  blood,  and  it  does  not  follow 
that,  because  it  is  dead,  secondary  growths,  unseen  and 
perhaps  unsuspected,  are  dead  also.*  I  believe  that  the 
paragraph  previously  quoted  in  this  chapter,  from  Dr. 
Cleaves,  much  more  nearly  represents  the  truth  of  this 
matter  than  estimates  formerly  made,  and  I  warn  the 
practitioner  against  making  promises,  or  even  finite  esti- 
mates at  all,  as  to  the  probable  length  of  time  during 
which  treatment  will  be  required.     It  may  possibly  be 

^Also,  a  tumor  apparently  dead  may  not  be  dead  to  its  very  cen- 
ter, which  is  nourished  only  at  second-hand,  so  to  speak,  by  the 
lymph  which  exudes  from  the  blood-vessels  at  the  periphery.  No 
malignant  tumor  produces  blood-vessels  of  its  own. 


^n  THE  CONQUEST  OF  CANCER 

that  the  case  is  really  analogous  to  that  of  the  treatment 
of  myxoedema  by  thyroid  extract,  though  I  do  not  think 
that  this  is  actually  so.  It  would  only  necessarily  be  so 
if  the  growth  of  cancer  were  due  to  defect  of  the  pancreas, 
a  supposition  which  is  not  warranted  by  the  present  evi- 
dence. 

I  make  no  prophecy  as  to  the  ultimate  place  which  tryp- 
sin and  amylopsin,  as  against  other  cancrotoxic  ferments, 
will  take  in  the  treatment  of  cancer,  nor  as  to  the  effect 
which  their  use  will  ultimately  have  upon  the  relations 
between  cancer  and  surgery.  Many  things  may  be  hoped 
and  expected,  but  "qui  vivra  verra."  Meanwhile,  I  am 
content  to  claim  for  the  treatment  that  it  demands  em- 
ployment in  every  case  of  malignant  disease  without  ex- 
ception, whether  other  treatment  be  employed  or  not. 
Already  it  may  be  said  that  it  is  apparently  no  longer 
necessary  for  any  one  within  reach  of  these  ferments  in 
an  active  state  to  suffer  from  cancer  cachexia,  from  the 
fcetor,  or  from  the  pain  of  the  disease.  If  I  make  no 
further  claim  at  present,  it  is  because  there  should  be  much 
more  than  sufficient  to  insure  for  the  treatment  as  wide 
a  trial  as  could  any  claims  whatever. 

There  may  be  noted  here  a  possible  contributory  ex- 
planation of  the  results  of  the  ferment  treatment  in  its 
various  forms.  It  is  well  known  that  in  many,  indeed 
most,  diseased  conditions,  the  number  of  white  cells  or 
leucocytes  in  the  blood  is  found  to  be  increased.  This 
leucocytosis,  as  it  is  called,  was  at  first  regarded  as  a 
pathological  symptom ;  it  is  now  conceived  as  a  protective, 
conservative,  or  compensatory  mechanism.  Thus  the 
cases  of  pneumonia — a  disease  usually  marked  by  high 
leucocytosis,  and  ending  in  most  cases  by  spontaneous 
recovery— in  which  leucocytosis  does  not  occur  are  com- 


THE  CLAIMS  OF  THE  TREATMENT    273 

monly  the  fatal  cases.     Some  measure  of  leucocytosis 
is  common  in  cancer,  and,  in  all  probability,  this  is  one 
of  those  significant  and  invaluable  facts  hitherto  practi- 
cally ignored  in  the  study  of  the  disease,  since  the  sur- 
geon,  for  instance,  cannot  stitch  a  leucocyte,   and  it  is, 
therefore,  less  than  "Hecuba  to  him."    Dr.  Lovell  Drage, 
whose  phrase  about  the  "stopping  power  of  the  old  gang" 
in  reference  to  new  forms  of  treatment  for  cancer  comes 
to  mind,  has  lately  shown  {Lancet,  Sept.  7,  1907)  that 
favorable  results,  up  to  a  point,  may  be  obtained  in  the 
treatment  of  cancer  by  the  use  of  drugs  which  are  known 
to  increase  the  number  of  leucocytes  in  the  blood-stream. 
It  occurs  to  me  that  the  use  of  turpentine  in  uterine  can- 
cer— for  which  Chian  turpentine  was  at  one  time  regarded 
as  curative,  so  useful  is  it — may  be  thus  explained,  since 
the  group  of  drugs  to  which  turpentine  belongs  (loosely 
called  the  volatile  oils)  are  known  to  cause  leucocytosis. 
Suggestive,  also,  is  the  observation  of  Prof.  Farmer,  that 
at  the  edge  of  a  cancer  the  leucocytes  seem  sometimes 
to  be  merging  into  the  cancer-cells.     We  may  note  this 
without  accepting  the  surely  wild  suggestion  that  cancer 
may  be  due  to  this  kind  of  unnatural  union.     I  should 
rather  be  inclined  to  interpret  it  as  evidence  of  the  man- 
ner in  which  the  leucocytes  attempt  to  fight  cancer.  Every- 
thing we  have  known  about  leucocytes  since  the  great 
work  of  Metchnikoff  some  decades  ago,  together  with  the 
fact  of  leucocytosis  in  cancer,  lends  probability  to  the 
supposition  that  the  leucocytes  fight  the  alien  cells  of  the 
growth  as  they  are  known  to  fight  alien  microbic  and  pro- 
tozoan cells,  such  as  those  of  malaria  and  infectious  dis- 
eases in  general.     In  all  cases  whatsoever  the  weapons 
used  by  both  sides  are  doubtless  ferments ;  and  I  am  per- 
fectly willing  to  entertain  the  supposition  that  the  leucocy- 


^74/  THE  CONQUEST  OF  CANCER 

tes  produce  a  cancrotoxic  ferment,  and  even  that  this  may 
possibly  explain  Prof.  Bier's  resuhs.  I  have  no  prejudice 
in  favor  of  trypsin  or  any  other  ferment,  need  I  repeat? 
Further,  the  work  of  Schmidt,  who  showed  that  cancer- 
cells,  after  eroding  a  blood-vessel  and  entering  the  blood- 
stream, are  often  occluded  and  destroyed  there,  not  only 
directs  attention  again  to  the  blood  as  a  holder  and  carrier 
of  cancrotoxic  ferments,  but  specially  directs  us  to  the 
leucocytes.  The  invading  cells  are  seen  to  be  surrounded 
by  a  blood-clot,  which  pins  them,  so  to  speak,  against  the 
wall  of  the  vessel.  Now,  all  blood-clots  are  known  to 
owe  their  origin  to  the  stimulation  of  the  leucocytes, 
which  produce  an  antecedent  of  the  so-called  "fibrin- 
ferment"  ;  this,  in  the  presence  of  lime  salts,  inducing 
coagulation  of  the  formerly  fluid  fibrinogen  of  the  blood 
serum.  It  is  possible  that  the  leucocytes  may  not  only 
begin  the  work  observed  by  Schmidt,  but  may  continue  it. 
In  this  connection  the  observations  so  minutely  and 
extensively  made  by  Dr.  Cleaves  are  worthy  of  note.  She 
found  not  merely  an  extraordinary  increase  in  the  num- 
bers of  leucocytes  of  a  certain  type,  but  also  a  marked 
and  practically  immediate  increase  of  the  leucocytes  in 
general,  under  the  pancreatic  treatment.  Surely  there  is 
abundant  reasoning  for  crediting  and  investigating  the 
supposition  that  this  leucocytosis  plays  a  part  in  the  pro- 
duction of  favorable  results  by  the  treatment.  I  would 
note  also  the  hypothesis  favored  by  Dr.  Cleaves  and  Dr. 
Beard,  that  the  specific  effect  of  the  amylopsin,  or  one  of 
its  effects,  may  be  to  stimulate  the  leucocytes  and  aid 
them  in  the  work  of  removing  the  glycogen  from  the 
tumor,  in  which  it  has  been  produced  by  the  proteid- 
splitting  action  of  trypsin — this  glycogen  appearing  in 
the  leucocytes  as  the  eosinophile  granules.    These  obser- 


THE  CLAIMS  OF  THE  TREATMENT    275 

vations  are  in  need  of  confirmation,  and  may  be  com- 
mended for  that  purpose.  But  in  any  case  it  is  evident, 
I  think,  that  the  question  of  the  production  and  function 
of  leucocytosis  in  cancer  is  one  that  demands  the  serious 
and  systematic  investigation  which  it  has  not  yet  received. 
What,  for  instance,  is  the  leucocyte  count  in  cases  of 
spontaneous  cure?  Like  the  many  other  questions  of 
great  moment  which  may  be  asked  regarding  these  cases, 
this  is  at  present  without  an  answer. 

The  thymus  gland  is  supposed  to  be  a  source  of  leu- 
cocytes, and  the  spleen  certainly  is.  Thymus  preparations, 
according  to  one  observer,  are  cancrotoxic  in  some  de- 
gree. I  should  recommend  the  spleen  for  study  as  a 
possible  source  of  a  cancrotoxic  ferment  or  ferments — 
which  may  be  leucocytic  or  really  derived  from  the  pan- 
creas, but  the  extraction  of  which  from  this  gland  would 
be  of  interest. 

What  are  the  fallacies  to  look  for?  Immeasurably  the 
most  important  in  the  case  of  this  disease  is  the  fallacy 
dependent  upon  a  false  premise.  If  the  disease  is  not 
cancer,  violet-leaves,  molasses,  or  any  other  irrelevant 
rubbish  may  seem  to  cure  it.  In  the  first  case  of  cure 
recorded,  that  of  a  cancer  of  a  vocal  cord,  no  microscopic 
examination  was  made.  It  might  have  been  an  innocent 
tumor.  I  do  not  think  any  one  could  read  the  account 
of  the  case  and  think  so,  but  still  in  itself  it  was  not  con- 
clusive. But  the  reader  is  now  aware  that  more  or  less 
successful  results  have  been  obtained  in  many  cases  where 
the  nature  of  the  disease  was  far  beyond  question,  whether 
by  the  naked  eye  or  the  microscope — where,  indeed,  it 
had  again  and  again  recurred  with  every  malignant  char- 
acter in  evidence.     The  second  fallacy — though  this  is 


276     THE  CONQUEST  OF  CANCER 

only  to  be  mentioned  for  form's  sake — is  that  dependent 
upon  the  fact  that  perhaps  once  in  fifty  or  one  hundred 
thousand  times  a  true  malignant  tumor  will  spontane- 
ously degenerate  and  disappear.  This  is  almost  the  rarest 
occurrence  known  to  pathology.  In  Mr.  Handley's  recent 
monograph,  Cancer  of  the  Breast  (Murray,  1906,  p.  156), 
is  reported  "the  most  convincing"  of  the  cases  of  sponta- 
neous cure  that  are  on  record.  Doubtless  there  are  other 
such  cases,  and  at  the  Heidelberg  Conference  on  Cancer, 
in  September,  1906,  there  was  a  tendency  to  admit  that 
the  spontaneous  cure  of  cancer  is  somewhat  less  rare  than 
used  to  be  supposed. 

At  this  time  of  day  it  is  no  longer  necessary  to  adduce 
arguments  against  the  view  that  in  every  case  where 
the  pancreatic  treatment  has  seemed  to  cause  the  retro- 
gression of  a  cancer,  the  disease  has  really  been  under- 
going spontaneous  cure.  The  results  have  been  repeatedly 
observed  in  various  parts  of  the  world  in  cases  which, 
until  the  treatment  was  employed,  were  visibly  active,  and 
where  the  growth  was  increasing  rapidly  in  size.  This 
was  the  case  with  Dr.  Beard's  mice,  though  the  argument 
has  been  absurdly  raised  by  persons  who  apparently  did 
not  read  the  account  of  the  experiments,  that  the  tumors 
were  undergoing  atrophy  in  any  case.  This  argument 
against  the  results  of  the  pancreatic  treatment  could  not 
possibly  be  alleged  by  any  one  who  had  watched  properly 
treated  cases  for  himself.  This,  however,  is  exactly  what 
not  one  in  a  thousand  of  the  critics  have  done. 

In  the  first  case  I  watched — it  was  under  the  care  of 
Dr.  Bonnefin  of  Leytonstone — in  February  and  March, 
1906,  I  found  myself  constantly  doubting  whether  the 
evident  disintegration  of  a  uterine  cancer  under  the  treat- 
ment was  not  due  to  bacterial  action — even  though  the 


THE  CLAIMS  OF  THE  TREATMENT   277 

previous  foetor  of  the  case  disappeared.  This  fallacy  has 
long  ago  been  excluded  by  experience,  but  Prof.  Von 
Leyden  and  his  workers  have  paid  special  attention  to 
it,  and  shown  that  the  results  following  the  use  of  trypsin 
are  due  to  a  true  ferment  action,  and  not  to  accidentally 
synchronous  bacterial  disintegration  of  the  growth.  This 
possible  source  of  fallacy  does  not  exist  in  unexposed 
tumors. 

Though  an  excessively  minute  percentage  of  cases  of 
malignant  disease  undergo  spontaneous  cure — a  fact 
which  in  itself  shows  that  the  remedy  for  cancer  must 
be  sought  in  the  tissues  and  secretions  of  the  body — the 
number  is  so  small  that  only  a  surgeon  here  and  there 
has  ever  seen  such  a  case — much  less  a  recurrent  case, 
such  as  have  furnished  the  majority  of  our  patients  hith- 
erto. For  practical  purposes,  then,  the  treatment  of  can- 
cer is  not  subject  to  the  capital  fallacy  which  makes  nine- 
tenths  of  all  therapeutic  claims  at  the  present  day  ridicu- 
lous. When  I  was  a  student  I  worked  in  two  adjacent 
wards,  in  one  of  which  the  proper  answer  to  a  question 
about  chorea  was  that  cases  last  in  general  for  about  six 
weeks,  the  symptoms  then  spontaneously  disappearing; 
while  in  the  other  the  answer  desired  was  that,  in  general, 
arsenic  cures  chorea  in  about  six  weeks.  The  point  for 
the  judicious,  if  dishonest,  student  was  to  remember 
whether  he  was  in  (say)  ward  28  or  ward  29.  In  his 
"Address  in  Medicine"  to  the  British  Medical  Association 
in  1907,  Dr.  Hale  White,  pleading  for  "accuracy  of 
thought  in  medicine,"  pointed  out  other  cases  of  the  kind, 
isuch  as  exophthalmic  goitre.  In  general,  patients  die  of 
a  disease  or  recover  from  it — ^the  word  cure,  as  applied 
to  the  doctor's  interference,  is  entirely  inapplicable.  One 
might  as  well  say  that  most  cases  of  pneumonia  are  cured 


^78  THE  CONQUEST  OF  CANCER 

in  ten  days  or  so,  or  that  the  doctor  cures  bronchitis  in  a 
fortnight;  while  it  cures  itself  in  two  weeks,  as  the  Irish- 
man observed.  This  fallacy,  and  that  of  attributing  the 
result  to  one  agent  or  another  according  to  taste,  such  as 
creasote  administered  to  a  consumptive  who  is  also 
undergoing  the  open-air  treatment,  infest  and  vitiate  to- 
day nearly  the  whole  of  medicinal  therapeutics,  which,  in 
the  average  hands,  is  simply  the  licensed  administration 
of  poisons  in  something  under  lethal  doses,  as  a  rule. 

In  the  treatment  of  cancer,  and  the  estimation  of  the 
results,  these  fallacies  can  be  excluded  without  difficulty. 
Almost  invariably — so  constantly  that  it  would  be  difficult 
or  impossible  to  find  any  observer  who  had  seen  two  ex- 
ceptions— the  disease  proceeds,  though  with  varying  pace, 
to  a  fatal  termination.  If  in  two  consecutive  cases  it 
disappeared  under  hypnotic  suggestion,  the  presumption 
would  be  practically  overwhelming  that  this  agent  had 
effected  the  cure.  The  argument  of  spontaneous  cure 
was  to  be  considered  when  the  first  case  was  recorded : 
the  second  sufficed  to  dispose  of  it  substantially,  and  it 
has  long  been  out  of  the  question.  The  other  source  of 
fallacy  is  relevant  in  cases  where  the  Rontgen  rays  have 
been  employed,  and,  of  course,  in  post-operative  cases 
where  the  surgeon  has  apparently  removed  everything. 
Such  cases  must  be  individually  analyzed.  In  the  ab- 
sence of  any  other  agents  which  mechanically  or  other- 
wise are  capable  of  curing  cancer,  favorable  results  must 
necessarily  be  attributed  to  the  pancreatic  ferments  them- 
selves.    Many  such  results  have  been  quoted  already. 

If,  however,  the  phrase  is  for  any  reason  preferred,  let 
it  be  stated  that,  when  the  pancreatic  treatment  is  prop- 
erly employed,  cases  of  cancer  commonly  show  a  tendency 
to  undergo  spontaneous  cure;  or  let  it  be  reported  that. 


THE  CLAIMS  OF  THE  TREATIVIENT    279 

in  spite  of  the  pancreatic  treatment,  the  patient  recovered 
or  was  benefited — as  might  be  reported  after  so  many 
therapeutic  adventures.  If  the  critics  will  take  the  thing 
from  us,  we  will  take  any  words  they  please  from  them. 

I  claim,  therefore,  that  the  capacity  of  the  pancreatic 
'treatment  to  cure  certain  cases  of  cancer  has  been  abso- 
lutely demonstrated,  though  it  should  never  cure  another. 
Nature  is  consistent,  however,  and  the  application  of  her 
methods  will  do  in  the  future  what  it  has  done  in  the  past. 
Trypsin  is  a  specific  remedy — whatever  others  there  be — 
for  cancer  according  to  the  embryologist  in  his  study;  it 
is  the  specific  remedy  for  cancer  according  to  the  chemist 
with  his  test-tubes ;  and  it  is  the  specific  remedy  for  can- 
cer according  to  the  clinician  at  the  bedside. 

A  grave  and  inevitable  responsibility  now  rests,  there- 
fore, upon  all  editors,  surgeons,  official  researchers,  pa- 
tients' friends  and  patients  themselves,  who  by  word  or 
writing  or  act  oppose  the  employment  of  the  new  treat- 
ment at  any  time  in  any  case  of  malignant  disease.  An 
appalling  indictment  may  be  framed  upon  those,  mostly 
an  anonymous  and  ignorant  assemblage,  who,  during  the 
past  two  years  or  so,  have  fought  this  method,  whether 
fairly  or  unfairly,  whether  with  the  rare  argument  or 
the  familiar  lie.  Some  forty-five  thousand  persons  have 
died  of  malignant  disease  in  Great  Britain  alone  since  I 
began  my  campaign  on  behalf  of  a  method  which,  from 
the  first,  was  reasonable,  supported  experimentally,  free 
from  risk,  and  without  an  effective  rival  in  the  world  for 
the  vast  majority  of  cases,  surgery  notwithstanding.  The 
question  is  one  of  life  or  death,  of  ease  or  agony,  for  very 
nearly  all  the  sixty  to  one  hundred  thousand  persons  now 
suffering  frorn  cancer  in  Great  Britain  alone,  and  many 
hundreds  of  thousands  elsewhere.     I  submit  that,  despite 


280  THE  CONQUEST  OF  CANCER 

the  legitimate  or  inherent  and  the  illegitimate  difficulties 
of  the  past  two  years,  the  treatment  has  now  established 
a  claim  to  trial,  if  not  indeed  to  universal  applause,  which 
cannot  be  resisted.  When  this  book  was  begun,  more 
than  a  year  ago,  I  was  still  in  some  doubt  whether  it 
would  ever  see  the  light,  whether  my  labor  was  not  worse 
than  wasted.  On  the  other  hand,  there  was  a  reasonable 
chance  that  if  I  did  as  much  work  as  possible,  even  while 
much  doubt  remained — doubt  which  perhaps  had  no  more 
basis  than  the  psychological  fact  which  leads  us  to  say 
that  a  thing  is  "too  good  to  be  true" — at  any  rate,  if  and 
when  the  evidence  proved  convincing,  no  priceless  time 
need  be  lost  before  publication :  here  time  was  not  money 
but  life,  many  lives :  and  ease  for  agony.  Now  that  the 
evidence  has  been  published  and  the  claims  of  the  new 
treatment  set  forth  to  the  best  of  my  ability,  the  grave  re- 
sponsibility of  delay,  which  has  so  long  haunted  me,  is 
transferred  to  the  shoulders  of  the  public  at  large ;  they 
alone  will  be  to  blame  if  the  new  hope  offered  them — 
offered  to  those  who  have  no  other  hope  in  the  world- 
is  renounced.  My  experience  has  been  that,  for  one 
doctor  who  has  written  to  me,  dozens  of  patients  or  their 
friends  have  written ;  and  it  is  evident  that  the  patient, 
and  those  who  love  the  patient,  must  on  the  whole  be 
more  eager  for  a  remedy  than  even  the  most  humane  or 
ambitious  doctor.  I  have  therefore  given  this  book  as 
popular  and  arresting  a  title  as  I  could  think  of ;  I  have 
not  gone  to  the  ordinary  publishers  of  medical  books; 
and  I  have  attempted  the  almost  impossible  task  of  writ- 
ing a  book  which  will  be  intelligible  to  the  layman  and 
useful  to  the  practitioner  and  the  scientific  student.  To 
these  last  I  express  my  regret  for  explaining  what  they 
know,  and  for  the  clumsiness  which  is  almost  inseparable 


THE  CLAIMS  OF  THE  TREATMENT   281 

from  the  avoidance  of  our  convenient  technical  phraseol- 
gy ;  but  it  was  necessary  that  the  pubHc  should  read  and 
act  without  delay,  and  I  have  chosen  the  means  best 
suited,  as  I  believe,  for  that  end.  This  book  is  written 
for  the  man  or  the  woman  who  has  cancer;  only  inci- 
dentally as  a  study  in  sociology,  or  as  an  account  of  cer- 
tain scientific  observations,  or  as  a  tribute  to  one  whom 
I  regard  as  a  pioneer  of  genius.  It  is  therefore  to  be 
judged,  not  by  its  title  nor  its  style,  nor  its  candor  when 
dealing  with  what  the  author  rightly  or  wrongly  believes 
to  be  dangerous  obstructions  to  truth,  but  by  the  validity 
or  invalidity  of  the  claims  which  have  been  made  for  the 
treatment  in  this  chapter,  and,  if  those  claims  be  found 
valid,  by  its  fitness  for  the  urgent  purpose  of  multiplying 
to  the  uttermost  and  at  the  earliest,  the  number  of  those, 
otherwise  substantially  hopeless,  in  whom  its  claims  may 
be  realized  in  whole  or  in  part.  Let  the  reader  imagine 
that  he  himself  has  an  inoperable  cancer — if  he  is  as  old 
as  thirty-five,  the  chances  are  one  in  twelve  that  this 
fate  is  in  store  for  him,  and  for  a  woman  they  are  as 
high  as  one  in  only  eight.  Let  him  then  condemn  me  as 
"premature"  if  he  can.  The  word  has  been  thrown  at 
me  often  enough,  and  it  is  the  least  offensive  of  many 
that  have  come  my  way,  but  it  has  not  yet  come  from  a 
patient.  And  as  "one  wise  man's  verdict  outweighs  all 
the  fools,"  so  one  patient's  verdict  on  the  claims  of  this 
treatment  outweighs  all  the  verdicts  of  all  those  who,  in 
no  need  of  help  themselves,  have  denied  the  existence  of 
that  which  they  could  not  or  would  not  see,  and  the  rea- 
sonableness of  that  which  they  could  not,  or  would  not, 
understand. 

If  I  have  been  censured  once  I  have  been  censured 
twenty  times  for  "exciting  false  hopes"  by  my  crusade 


28^  THE  CONQUEST  OF  CANCER 

on  behalf  of  the  new  treatment,  or  rather,  on  behalf  of 
the  cancer-patient.  I  have  been  accused  of  criminal  and 
brutal  cruelty,  and  so  forth,  by  the  leading  medical  jour- 
nals in  England,  and  by  some  of  the  lay  papers  in  Amer- 
ica. Here  I  will  expose  this  argument  for  the  grossly 
dishonest  and  puerile  thing  it  is.  I  might  argue  that 
even  hope  may  be  worth  something  in  itself,  or  that  the 
question  of  the  falsity  of  the  hopes  I  aroused — ^hopes  in 
many  cases  justified — was  begged  by  these  writers ;  but 
these  arguments  need  not  detain  us.  We  need  only  note, 
in  the  first  place,  that  certainly  in  the  majority  of  cases  of 
operation  for  cancer — and  the  number  of  these  is  gigantic 
— the  surgeon  arouses  hopes  of  cure..  At  least  he  will 
say  that  he  will  do  his  best,  though  he  can  promise  noth- 
ing :  and  on  these  terms  he  is  permitted  to  operate.  A\"hat 
proportion  of  all  the  surgeons  who  daily  arouse  these 
hopes  in  their  patients  have  ever  justified  them  in  a  single 
instance  ?  I  am  content  merely  to  ask  the  question,  and 
I  do  not  by  any  means  suggest  that  the  suggestion  of  a 
chance  of  cure  is  improper,  though  the  chance  be  only 
infinitesimal. 

But,  secondly,  in  answer  to  the  British  Medical  Jour- 
nal, the  Bradshaw  Lecturer  of  1906,  and  all  the  others 
who  have  censured  me  on  this  ground.  Is  it  not  the 
rule,  rightly  insisted  upon  and  almost  invariably  prac- 
ticed, that  the  word  cancer  shall  not  be  mentioned  before 
a  patient?  Does  not  every  doctor  regularly  and  rightly 
keep  the  patient  unaware  of  the  nature  of  the  disease  as 
long  as  possible,  informing  only  a  responsible  relative? 
Every  one  knows  that  it  is  the  duty  of  the  doctor,  a  duty 
to  which  every  medical  student  is  trained,  a  duty  which 
leads  to  the  use  of  all  sorts  of  euphemisms  for  the  word 
cancer,  to  excite  or  encourage  in  his  cancer-patients  hopes 


THE  CLAIMS  OF  THE  TREATMENT    283 

which  he  hnozvs  to  be  absolutely  false.  This  being  the 
recognized  duty  of  the  profession,  its  spokesmen  have  the 
rare  effrontery  to  blame  me  for  exciting  hopes  which  I 
believe  to  be  well  grounded.  That  they  have  in  many 
cases  been  proved  to  be  well  grounded  adds  nothing  at  all 
— because  nothing  can  be  added — to  the  weight  of  my 
reply.  It  is  the  duty  and  practice  of  the  profession,  not 
only  in  cancer,  but  always,  except  for  special  reasons — 
as,  say,  the  need  of  making  a  will — to  "keep  up  the  pa- 
tient's spirits,"  remind  him  that  while  there  is  life  there 
is  hope,  conceal  the  name  of  a  dreaded  disease  and  its 
nature  as  long  as  possible.  This  is  deliberate  lying,  of 
course,  but,  in  common  with  all  the  world,  I  defend  and 
approve  it.  Now  if  all  mankind  is  justified,  on  the 
grounds  of  common  humanity,  in  exciting  hopes  known 
to  be  false,  I  will  permit  myself  the  license  of  exciting 
hopes  I  believe  to  be  true.  Of  all  the  impudent  and  dis- 
ingenuous things  that  have  been  said  about  trypsin  and 
its  advocates,  I  think  this  is  perhaps  the  foremost,  though 
I  would  not  care  to  be  too  sure. 

I  have  claimed  for  this  treatment  that  it  should  be  em- 
ployed in  all  cases  of  malignant  disease.  In  no  case  that 
I  have  submitted  to  Dr.  Beard,  on  application  from  read- 
ers of  my  articles,  has  he  suggested  that  the  case  was 
unsuitable,  and  repeatedly  it  has  been  employed  in  cases 
where  success  was  absolutely  beyond  all  possibility. 
(Several  of  the  Middlesex  Hospital  cases  were  quite 
obviously  of  this  kind.)  But  even  if  there  was  no  credi- 
ble chance  of  cure,  there  was  the  incredible  chance,  and 
I  honestly  believe  that  the  idea  of  picking  his  cases  for 
treatment,  as  is  constantly  done  by  physicians  and  sur- 
geons all  the  world  over  when  they  are  trying  to  prove 
the  value  of  a  method,  has  never  entered  Dr.  Beard's 


284J  THE  CONQUEST  OF  CANCER 

mind.  I  quote  from  Dr.  Macfie's  admirable  little  book, 
The  Romance  of  ikf^cfian^,  a  paragraph  concerning  anoth- 
er scientific  worker,  like  Dr.  Beard,  "not  even  a  medical 
man,"  but  a  supreme  benefactor  of  mankind  and  the 
greatest  master  of  medicine  of  all  time  hitherto : 

"And  Pasteur  was  not  only  kind,  he  was  also  noble  and 
magnanimous.  When  his  treatment  for  hydrophobia  was 
still  suh  judice,  when  his  reputation  depended  on  its  suc- 
cess, a  little  child  was  brought  to  him  bitten,  thirty-seven 
days  before,  by  a  rabid  dog.  It  was  almost  certainly  too 
late  to  save  the  child,  and  Pasteur's  assistants  pointed 
out  to  him  that  if  the  child  died  the  death  would  be  laid 
to  his  account  and  would  discredit  his  discovery.  They 
begged  him,  therefore,  to  make  no  attempt  to  save  the 
child's  life.  'No,'  said  he,  'if  the  child  have  one  chance 
in  ten  thousand  of  recovery  I  ought  to  try  everything.' 
And  he  gave  the  child  the  chance,  and  bore  without  flinch- 
ing the  opprobrium  which  her  death  brought  to  him." 

That  "the  patient  must  have  every  chance"  is  the  first 
axiom  of  medicine ;  and  I  claim  for  the  pancreatic  treat- 
ment that  the  patient  who  dies  of  cancer  without  any 
attempt  to  employ  it,  has  not  had  every  chance.  I  claim 
further  that  the  cancer-patient  has  practically  no  other 
chance,  and  that,  unless  this  primary  axiom  of  the  healing 
art  be  repudiated,  neglect  to  employ  the  treatment  will 
henceforth  be — as  it  has  been  since  the  time  when  public 
attention  was  first  drawn  to  the  treatment — wholly  with- 
out excuse  or  defence.  The  practitioner  who  fails  to 
obtain  beneficial  results  runs  no  risk  of  personal  discredit, 
at  present  at  any  rate;  the  only  persons  discredited  will 
be  Dr.  Beard  and  myself;  but  the  practitioner  who  will 
attend  to  details,  as  the  surgeon  does  in  his  work,  will  as- 
suredly serve,  and  may  save,  his  patient. 


CHAPTER  XVIII 

SOME  WARNINGS 

Having  put  my  hand  to  the  plough  in  the  matter  of 
informing  the  pubHc,  to  the  best  of  my  knowledge,  re- 
garding the  progress  of  the  war  with  cancer,  and  having 
myself  suffered  many  hard  blows  meanwhile,  I  here  de- 
vote myself  to  a  matter  in  which  I  shall  certainly  be  ap- 
proved by  all  honest  persons,  whatever  their  attitude 
towards  the  pancreatic  treatment  of  the  disease.  I  be- 
lieve I  foresee  certain  all  but  inevitable  developments  of 
no  desirable  kind,  against  which  I  wish  to  warn  the  pub- 
lic. It  would  be  a  poor  service  to  give  hints  for  mal- 
practice to  the  ill-inclined,  but,  unfortunately,  it  is  impos- 
sible to  doubt  that  the  hints  are  unnecessary  to  his 
activity.  The  best  course,  then,  is  to  point  out  the  oppor- 
tunities of  which  he  will  be  certain  to  avail  himself;  so 
that  the  public,  forewarned,  may  be  forearmed.  The 
most  valuable  prophecies  of  evil  are  not  those  of  Cassan- 
dra, which  always  came  true,  but  those  which  effect  their 
own  falsification,  and  it  is  such  prophecies  that  I  desire 
to  make. 

The  work  of  Dr.  Beard,  the  recent  work  of  Prof.  Von 
Leyden,  with  a  supposed  "liver-ferment,"  and  of  Prof. 
Bier  with  a  "blood-ferment"  of  uncertain  origin  and 
nature,  each  of  these  having  a  proven  remedial  action 
upon  cancer,  offers,  or  will  soon  offer,  rare  and  golden 
opportunities  to  the  tradesmen — or  rather,  the  dishonest 
and  wholly  mercenary  tradesmen — who  unfortunately 
cannot  be  excluded  by  any  known  means,  universal  pub- 
licity in  all  cases  alone  excepted,  from  the  noble  pro- 

285 


286  ,THE  CONQUEST  OF  CANCER 

fession  of  medicine.  It  is  a  chance  for  the  qualified — 
often  highly-qualified — quack  who  is  the  curse  of  the 
profession.  I  think  it  quite  certain  that — failing  my 
efforts  to  prevent  it — the  next  apparent  development  in 
the  treatment  of  cancer  will  be  the  introduction  and  ex- 
ploitation of  a  new  "cancer-serum."  The  wonderful  anti- 
diphtheritic  serum  has  led  the  public  and  the  profession 
to  look  favorably  upon  the  word. 

We  often  talk  about  the  vis  medicatrix  Naturce.  Now, 
the  work  of  Dr.  Beard,  and  all  who  have  subsequently 
labored  in  a  substantial  way  at  the  problems  of  cancer, 
shows  positively  that  the  body  itself,  and  not  any  vege- 
table or  mineral  or  knife,  can  and  does  provide  a  specific 
remedy  for  cancer — this  surely  being  the  evident  ex- 
planation at  last  of  the  spontaneous  cures  which,  though 
excessively  rare,  do  occasionally  occur.  Thus  it  is  true 
that  a  "serum"  derived  from  the  liver,  or  the  blood,  or 
the  thymus,  or  some  other  organ,  may  conceivably  be  pre- 
pared, which  does  not  consist  of  the  pancreatic  ferments, 
masked  under  another  name;  and  such  a  "serum"  may 
prove  more  effective  than  trypsin  and  amylopsin — though 
this  I  may  personally  believe  to  be  improbable.  Now  I 
elsewhere  warn  the  reader  against  myself,  on  general  his- 
torical principles,  as  a  judge  of  anything  that  threatens 
to  supersede  the  pancreatic  ferments,  but  the  warning  is- 
unnecessary  here,  for  the  public  and  the  profession  alike 
have  a  simple  and  infallible  and  costless  means  of  judg- 
ing for  themselves.  It  will  be  attempted,  unless,  per- 
haps, this  prophecy  averts  it,  to  produce  a  serum  which, 
though  the  phrase  will  not  be  used  by  its  exploiters,  will 
in  fact  be  of  secret  composition,  asserted  to  be  capable  of 
manufacture  only  under  the  direction  of  one  man — per- 
haps a  German  professor,  perhaps  a  Parisian  surgeon, 


SOME  WARNINGS  287 

perhaps  some  one  else.  Some  "institute"  or  other  may 
ostensibly  be  the  source  of  this  wonderful  preparation. 
We  shall  be  told  plausible  tales  as  to  its  source  in  some 
gland  or  other,  not  formerly  mentioned  in  this  connection, 
such  as  the  spleen,  or  any  other  the  function  of  which  is 
obscure ;  but  the  mode  of  preparation  will  not  be  confided 
to  us.  We  shall  learn  merely  that  it  is  exceedingly  diffi- 
cult and  costly  to  prepare,  the  processes  being  of  infinite 
delicacy  and  requiring  a  great  length  of  time;  and  that, 
since  the  gland  in  question  is  a  small  one,  and  the  product 
highly  concentrated,  only  minute  quantities  of  the  serum 
can  be  obtained  until  the  resources  of  the  "institute"  are 
extended.  The  dose,  however,  will  be  somewhat  large. 
Hence  the  expense  will  be  enormous ;  but  civilization  has 
many  millionaires,  and  many  of  these  have,  or  soon  will 
have,  cancer. 

This  new  serum  will  have  an  incalculable  advantage 
over  all  cancer-cures,  except  one,  that  have  hitherto  ap- 
peared ;  it  will  be  more  or  less  effective.  If  well  prepared 
it  will  certainly  relieve  pain,  remove  foetor,  and  abolish 
discharge  where  these  exist.  For  such  purposes  it  will 
require  free  local  application,  and  I  have  already  com- 
mented upon  the  grave  expense  of  its  incommunicable 
preparation.  But  it  will  do  more  or  less  what  it  pro- 
fesses to  do:  certain  cases  of  well-authenticated  cancer 
it  may  very  possibly  cure :  all  without  exception  it  will 
probably  benefit — being  employed  with  great  skill — in 
such  an  unmistakable  fashion,  and  so  quickly,  that  every 
one  will  have  to  recognize  the  fact — and  the  "resources 
of  the  institute"  will  be  increased.  However,  there  will 
always  be  only  a  tiny  quantity  just  available  for  use — 
though  never  none  at  all — and  this  may  have  to  be  bid  for 
by  rival  purses,  probably  American. 


288     THE  CONQUEST  OF  CANCER 

This  is  not  an  imaginary  picture ;  my  imagination,  I 
hope,  is  not  morbid  enough  or  uncharitable  enough  for 
that.  These  things  have  happened  before,  and  they  will 
happen  again,  unless  we  can  help  it.  I  earnestly  warn 
the  public  and  the  profession  to  beware  of  any  such 
"serum"  w^hen  it  appears ;  and  the  warning  is  all  the 
more  and  not  the  less  necessary  because,  for  the  first 
time  in  history,  it  will  doubtless  be  of  some  real  value, 
greater  or  less.  If  trypsin  and  amylopsin  can  be  super- 
seded in  the  treatment  of  cancer — which,  though  I  do  not 
expect  it,  I  certainly  hope,  for  they  lack  ideal  rapidity 
of  action,  as  an  instance — let  the  new  discoverer  give  his 
knowledge  for  nothing,  but  everything  worth  having,  to 
the  whole  world,  as  Dr.  Beard  has  done  from  the  first, 
like  his  peers  of  yore,  Pasteur  and  Lister  and  Jenner  and 
Simpson.  If  he  be  a  medical  practitioner  he  will  not  lose 
in  the  long  run,  even  monetarily ;  and  if,  like  Dr.  Beard, 
he  be  not,  at  least  he  may  gain  gratitude,  without  having 
to  face  the  abuse  that  has  been  Dr.  Beard's  portion  and 
mine. 

But  if  trypsin  cannot — or  cannot  yet — be  superseded 
by  some  other  ferment  (for  a  ferment  it  assuredly  must 
be)  still  more  powerful,  not  less  safe,  and  more  speedy, 
there  is  nothing  but  knowledge  and  judgment  on  the 
part  of  those  whom  I  now  attempt  to  forewarn,  to  pre- 
vent any  one — and  especially  the  highly  qualified  and 
famous  variety  of  quack — from  preparing  a  "serum,"  the 
essential  part  of  which  will  be  the  pancreatic  ferments, 
keeping  its  composition  and  mode  of  preparation  secret, 
and  following  the  unworthy  examples  of  old  and  recent 
times. 

The  public  is  possessed  of,  or  can  obtain  at  any  time, 
all  the  information  that  exists  regarding  the  pancreatic 


SOME  WARNINGS  S89 

ferments.  For  that  matter,  any  one  may  purchase,  at  a 
fair  price,  the  splendid  recent  preparations  of,  for  in- 
stance, the  great  American  firm  of  pioneers  in  this  path 
and  may  make  a  "serum"  of  his  own  without  difficulty. 
The  sole  disadvantage  to  be  set  against  the  overwhelm- 
ing advantages — money  apart — of  having  no  secret  and 
telling  all  you  know,  is  that  thieves  and  liars  exist  who 
can  and  may  use  for  their  own  nefarious  purposes  the 
knowledge  supplied  for  the  public  good. 

Doubtless  the  proteolytic  activity  of  the  "serum"  could 
be  readily  ascertained,  and  doubtless  in  time  its  true  na- 
ture would  appear,  but  the  men  who  have  more  money 
than  judgment  would  be  swindled  meanwhile,  and  the 
thief  would  prosper  exceedingly.  All  the  conditions — 
such  as  the  obscure  nature  of  ferments,  and  the  difficulty 
or  impossibility  of  their  absolute  identification — make  this 
fraud  peculiarly  easy  '.hut  the  test  of  it  shall  he  its  secrecy, 
and  no  chemical  test  will  be  necessary  if  that  one  is  con- 
clusive. This  test  will  exclude  no  real  advance  upon 
trypsin,  if  such  be  made.  Meanwhile  we  may  remind 
ourselves  that,  to  current  physiological  science,  trypsin 
is  by  far  the  most  powerful  of  all  known  proteolytic  or 
proteid-digesting  ferments,  and  amylopsin  similarly  by  far 
the  most  powerful  of  all  known  ferments  of  its  class.  It 
is  quite  possible  that  this  warning  may  frighten  off  the 
thieves,  and  I  will  take  my  chance  of  being  told  that  it 
was  unnecessary,  as  I  well  know  it  is  not.  It  can  hurt  no 
honest  man. 

So  much  by  way  of  a  warning  to  the  wealthy,  for  whose 
especial  benefit  so  many  serums  and  unique  methods  of 
treatment  exist — ^the  marvelous  operation  that  only  one 
surgeon  can  perform  being  another  variety  of  the  same 
trick.     We  turn  now  from  the  wealthy  patient  and  the 


290     THE  CONQUEST  OF  CANCER 

qualified  quack,  to  the  poor  patient  and  the  unqualified 
quack,  and  to  the  many  who  "do  not  believe  in  doctors," 
but  will  swallow  anything  in  the  way  of  lotions  or  lies 
from  the  man  who  professes  to  know  more  than  doctors 
do.  These  two  classes  of  people,  each  of  whom  we  have 
always  with  us,  suffer  in  their  hundreds  of  thousands 
from  cancer,  and  have  long  been  the  prey  of  the  ordinary 
humble  cancer-quack  of  all  varieties.  This  cancer-quack 
is  on  his  last  legs,  and  very  soon  the  final  specimen  of 
him  will  go  to  his  unhonored  grave,  for  the  same  reason 
as  that  which  explains  why  there  are  no  malaria-quacks. 
A  malaria-quack  could  not  stand  up  against  quinine :  it  is 
only  the  disease  for  which  no  cure  exists  that  the  quacks 
profess  to  cure.  But  for  a  little  while  to  come  the  cancer- 
quack,  and  the  man  who  treats  the  people  who  do  not 
believe  in  doctors,  will  have  a  rare  harvest — unless  the 
public  will  learn  sense  in  time.  The  pretender  need  run 
no  risks.  He  need  not  make  any  injections  of  the  fer- 
ments, for  mere  local  application  to  accessible  cases — as 
most  cases  are  or  too  soon  become — will  accomplish  more 
than  any  means  hitherto  known  have  accomplished.  This 
alone  will  usuall}'  abolish  all  discharge  and  all  foetor,  and 
relieve  pain — practically  always  if  the  man  be  competent. 
These  results  will  be  sufficient  to  substantiate  his  claim 
in  the  eyes  of  his  patients,  for  a  time,  and  he,  too,  will 
flourish  exceedingly. 

If  he  really  does  good,  why  should  I  seek  to  prevent 
him?  Because  I  know  that,  except  in  the  rarest  and 
most  superficial  cases — if  then — he  will  never  cure  his 
patient  (assuming  the  disease  to  be  really  cancer),  and 
because  I  know  that  infinitely  more  than  he  will  accom- 
plish may  be  accomplished  by  the  injections  which  he 
dare  not  make.    Formerly  his  pretensions  were  soon  ex- 


SOME  WARNINGS  291 

posed,  and  he  was  dismissed  for  the  liar  he  was :  now  he 
may  markedly  benefit  the  patient,  in  non-essentials,  for 
months  at  a  time,  meanwhile  preventing  the  patient  from 
undergoing  the  only  adequate  form  of  treatment.  On 
the  whole,  he  will  be  thus  a  far  more  pernicious  person 
than  before,  even  though  he  will  be  able  to  do  some  good 
now  and  could  do  none  formerly.  Quite  apart  from  any- 
thing more,  trypsin  has  absolutely  substantiated  its  claim, 
in  every  case  of  exposed  cancer,  to  control  discharge  and 
foetor  by  its  rapid  and  complete  digestion  of  the  dead 
and  dying  surface  of  a  cancer,  and  this  it  does  without 
the  slightest  pain — very  much  on  the  contrary — and  with- 
out the  slightest  risk.  In  ni)^  judgment  it  is  now  criminal 
negligence,  and  should  be  regarded  as  professional  mal- 
practice, not  to  employ  it  for  this  purpose  alone,  even 
though  the  doctor  absolutely  denies  that  it  can  do  any- 
thing whatever  to  living  cancer  cells.  But  see  the  power  of 
the  charlatan — a  power  of  which,  I  hope,  the  methods  of 
publicity  which  have  proved  so  essential,  and  have  been 
so  much  reprobated,  will  deprive  him.  The  control  of 
foetor  and  discharge  immensely  improve  the  color,  the 
appetite,  and  the  general  health  of  the  patient — even 
though  the  tumor  be  growing  as  rapidly  and  actively  as 
ever,  or  more  so.  I  have  no  fear  in  making  this  admis- 
sion. Thus  the  charlatan  can  give  by  the  mouth  any 
nostrum  of  his  own,  or  the  "healer"  by  sacred  phrases  or 
incantations  can  proceed  with  his  methods,  and  they  will 
get  the  credit  of  the  general  improvement.  Voltaire  re- 
marked that  "incantations  and  arsenic  will  kill  any  num- 
ber of  sheep" :  and  incantations  and  a  little  trypsin  locally 
will  do  wonders  in  any  exposed  cancer :  but  the  patient 
is  being  killed  by  inches  all  the  same,  though  I  admit 
that  the  control  of  the  foetor  and  discharge  may,  nay, 


303     THE  CONQUEST  OF  CANCER 

almost  always  must,  of  themselves  prolong  life.  If  the 
proper  treatment  could  do  no  more  than  merely  local 
treatment  will  do,  the  charlatan  and  the  "healer"  might 
be  left  alone :  it  might  be  a  duty  to  recommend  trypsin 
to  them,  since  so  it  might  benefit  persons  who  "don't 
believe  in  doctors" :  but  trypsin  can  do  far  more,  and  so 
it  is  a  duty  to  interfere  with  the  charlatan  and  the  healer, 
who  dare  not  apply  the  complete  treatment,  and,  having 
never  heard  of  Lister,  would  doubtless  cause  lamentable 
abscesses  if  they  did. 

Yet  another  prophetic  warning:  and  this  for  the  aver- 
age sensible  middle-class  man,  whose  purse  is  too  small 
to  tempt  the  qualified  vender  of  secret  serums,  and  who 
has  too  much  sense  to  deal  with  the  cancer-quack,  or 
those  who  profess,  honestly  or  dishonestly,  to  cure  cancer 
by  Christian  Science  or  the  like — cancer,  like  decayed 
teeth,  being  one  of  the  few  mountains  which  even  faith 
will  not  move.  The  cancer  patient  belonging  to  this 
class,  safe  from  the  foregoing  risks,  has  risks  of  his  own 
to  run.  He  is  familiar  with  the  fact  that  surgeons  differ 
widely  in  skill,  and  that  their  fees  differ  accordingly,  as 
they  should  on  all  sound  principles  of  economics  or  jus- 
tice. He  knows  that  no  monetary  sacrifice  of  which  he 
is  capable  is  too  great  if  it  means  the  difference  between 
the  surgeon  who  may,  once  in  many  times,  effect  an  abso- 
lute and  final  cure,  and  the  surgeon  who  always  leaves 
part  of  the  disease  behind.  Now  it  must  be  made  clear 
that  the  case  of  the  pancreatic  treatment  is  quite  differ- 
ent. I  will  not  say  for  a  moment  that  it  is  on  all  fours 
with  the  treatment  of  malaria  by  quinine ;  for  it  is  a  matter 
needing  cleanliness  in  the  surgical  sense,  assiduity,  pa- 
tience, conscientiousness  and  other  qualities  which  are 
not  too   common.      But  though  it  makes   requirements 


SOME  WARNINGS  293 

which  are  not  universally  to  be  obtained,  they  are  re- 
quirements which  can  be  often  met.  They  are  not  re- 
quirements which  leave  or  should  leave  any  room  in  the 
future  for  any  such  person  as  a  "cancer-specialist,"  and 
the  fact  is  worthy  of  insistence.  My  experience  of  the 
past  two  years,  or  little  less,  abundantly  shows  that  prom- 
inent and  famous  specialists — outside  Germany — may 
fail,  from  sheer  carelessness,  or  the  lack  of  faith  which 
leads  them  to  blame  the  method  instead  of  their  method ; 
while  the  ordinary  practitioner,  devoting  himself  to  the 
case,  and  not  above  consulting  non-practitioners  like  Dr. 
Beard  or  myself,  will  succeed.  There  is  no  room,  then,  I 
repeat,  and  I  believe  there  never  will  be  room,  for  the 
"cancer-specialist,"  in  the  ordinary  sense  of  the  word, 
but  only  for  the  cancer-specialist  who  is  a  specialist  in 
all  diseases  simply  because  he  has  the  special  qualities 
which  make  him  a  good  practitioner.  Such  a  man  is  en- 
titled to  his  success  in  any  field,  and  he  earns  immeas- 
urably larger  fees  than  he,  or  even  the  specialist  so-called, 
ever  receives :  but  it  is  not  primarily  fees  that  he  is  after, 
and  therefore  he  will  not  pitch  them  too  high.  Therefore, 
I  say  to  the  ordinary  sensible  middle-class  man,  beware 
of  the  practitioner  who  demands  exceptional  fees,  and 
of  his  claim  that  he  is  a  specialist  in  the  treatment  of 
cancer.  No  conceivable  device  will  keep  this  kind  of 
man  out  of  the  profession,  in  which  the  colossal  ignorance, 
of  the  public  affords  him  countless  opportunities ;  but  his 
deeds  will  betray  the  mark  of  the  beast  to  those  who 
look  for  it,  and  the  outside  of  the  sick-room  door  is  his 
appointed  place  in  this  world,  whatever  be  his  prospects 
hereafter. 

Beware,  also,  of  the  man  who  promises  too  much,  or 
rather  too  little,  in  the  matter  of  time.     We  do  not  at  all 


294!'  THE  CONQUEST  OF  CANCER 

know  the  nature  of  the  conditions  which  permit  the 
growth  of  cancer :  that  is  a  point,  and  a  most  important 
one,  elucidated  in  no  degree,  so  far,  by  Dr.  Beard  or  his 
great  German  followers:  though  I  believe  it  will  shortly 
be  explained.  Meanwhile  it  is  possible  that,  as  Dr. 
Cleaves  hinted  in  her  admirable  paper  in  the  A^czv  York 
Medical  Record  (Jnnc  i,  1907),  in  some  cases,  if  not  in 
all,  the  use  of  trypsin  may  have  to  be  continued,  perhaps 
only  at  intervals,  throughout  life;  just  as  the  use  of  the 
essential  secretion  of  the  thyroid  gland  has  to  be  con- 
tinued throughout  life  in  cases  of  myxcEdema  and  cre- 
tinism. The  man  who  promises  that  the  treatment  will 
only  require  a  few  weeks  or  months,  and  that  thereafter 
the  patient  will  be  cured  and  remain  cured,  without  fear 
of  any  recurrence,  and  without  any  further  need  of 
trypsin,  may  happen  to  be  right,  but  he  is  an  ignorant 
man  of  the  worst  type,  one  ignorant  even  of  his  own 
ignorance.     Let  such  be  shunned. 

Normal  trophoblast  begins  to  degenerate  about  the 
seventh  week  of  ante-natal  life,  but  its  remains  can  be 
detected  at  birth.  Dr.  Beard  insists  that  the  process  of 
the  digestion  of  normal  trophoblast  is  very  slow,  lasting 
for  many  m.onths ;  and  so,  especially  in  cases  operated 
upon  and  thus  stimulated  by  the  surgeon,  may  we  expect 
the  digestion  of  "irresponsible  trophoblast,"  or  cancer, 
to  be  slow,  even  under  the  best  treatment.  Beware,  then, 
of  the  man  who  promises  too  much  in  this  respect. 

Though  the  treatment  is  necessarily  prolonged,  except 
in  the  early  and  favorable  cases,  not  one  of  which  has  yet 
come  under  treatment  in  any  part  of  the  world,  so  far  as 
I  know,  its  cost,  per  week  or  month,  has  no  occasion 
whatever  to  be  appreciably  higher  than  medical  treatment 
in  general.     The  doctor's  visit  need  be  of  only  the  usual 


SOME  WARNINGS  295 

average  length,  and  the  pancreatic  preparations  are  much 
less  costly  than  a  host  of  commonly  used  drugs,  if  these 
be  of  good  quality. 

I  issue  all  these  warnings  because,  from  the  very  first, 
I  have  been  writing  and  working  in  the  interests  of  the 
public  at  large,  and  because  I  have  no  desire,  on  the  other 
hand,  to  benefit  any  individual  practitioner  or  group  of 
practitioners  or  chemists.  I  write,  as  I  have  written — not 
primarily  for  the  medical  profession,  nor  for  the  surgeons, 
as  is  evident  enough — but  for  the  man  and  the  zvonian 
who  have  cancer: — at  any  given  time  sixty  thousand  in 
Great  Britain  alone,  according  to  one  estimate,  and  a 
hundred  thousand,  acording  to  another,  and  a  more  prob- 
able one.  I  believe  this  chapter  will  serve  them,  and 
those  who  love  them,  and  I  will  content  myself  with 
their  verdict  on  it.  The  critic  who  has  not  cancer  I  am 
entitled  to  ask  the  grounds  of  his  interference.  Is  he  a 
surgeon  who  lives  largely  by  operating  on  the  disease, 
for  instance,  or  what  is  he,  and  what  is  his  business  with 
it  and  knowledge  of  it?  Let  us,  as  a  novelty,  have  his 
name.  One  man  in  twelve,  and  one  woman  in  eight,  over 
the  age  of  thirty-five,  die  of  this  disease.  Let  the  critics 
wait  a  little  till  they,  in  their  proportion,  have  cancer,  and 
their  business  with  my  writings  is  indisputable.  When, 
their  turn  comes,  as  it  inevitably  will  come,  to  many  who 
have  criticized  and  condemned,  while  utterly  failing  to 
provide  that  real  criticism  of  which  every  new  discovery 
is  in  particular  need,  and  which  this  has  never  had  from 
outside,  I  hope  with  all  my  heart  that  they  will  renounce 
all  consistency  and  give  the  new  remedies  the  full  and 
early  trial  from  which  they  have  dissuaded  so  many  of 
their  fellow-beings  who  were  without  other  hope  or  help 
in  all  the  world. 


CHAPTER  XIX 

AMYLOPSIN  AND  ECLAMPSIA 

The  present  chapter,  it  must  be  recognized  at  once,  is 
in  the  condition  of  Dr.  Beard's  theory  of  the  nature  of 
cancer  when  it  was  first  announced  in  1902.  That  is  to 
say,  it  is  wholly  theoretical  or  speculative,  and  is,  at  pres- 
ent, without  any  kind  of  experimental  basis.  There  is 
known  to  the  obstetrician  a  terrible  disease  which  is  called 
eclampsia.  There  is  nothing  which  he  fears  so  much, 
since  there  is  nothing  for  which  he  can  do  less.  It  is 
said  to  occur  in  one  case  of  pregnancy  in  about  three 
hundred  and  fifty,  and  most  commonly  in  first  pregnan- 
cies, as  also  in  cases  of  twins.  The  symptoms  are  those 
of  poisoning  of  the  nervous  centers.  Those  first  observed 
"consist  in  complete  or  partial,  temporary  or  permanent, 
loss  of  vision,  flashes  of  light  before  the  eyes,  vertigo, 
headache,  drowsiness,  mental  depression,  nausea  and  con- 
stipation." Albumin  is  found  in  the  urine.  These  symp- 
toms may  lead  up  to  most  aggravated  and  dangerous  con- 
vulsions. The  treatment  is  extremely  unsatisfactory,  but 
if  the  patient  survives  the  emptying  of  the  womb  she  will 
almost  certainly  recover. 

There  are  many  and  various  theories  of  the  nature  of 
this  disease.  There  is  no  need  here  to  discuss  those  which 
are  demonstrably  untrue.  Undoubtedly  that  for  which 
most  support  exists  is  the  theory  of  Stumpf,  that  the  fits 
are  due  to  the  circulation  in  the  blood  of  some  poison 

296 


AMYLOPSIN  AND  ECLAMPSIA  29t 

produced  by  an  abnormal  decomposition  in  either  mother 
or  child.  He  believes  that  under  abnormal  processes  of 
decomposition  a  substance  free  from  nitrogen,  toxic  in 
its  action,  perhaps  acetone,  or  a  body  resembling  it,  which 
reacts  to  the  same  test,  may  be  formed.  This  theory 
has  recently  been  supported  by  Fehling.^  According  to 
him,  it  may  be  that  the  metabolism  of  the  foetus  and  the 
transference  of  the  foetal  products  into  the  maternal  cir- 
culation are  of  more  importance  than  has  hitherto  been 
supposed.  The  nephritis  of  pregnancy  is,  he  thinks,  most 
probably  not  the  cause  of  eclampsia,  but  the  first  sign  of 
intoxication,  of  which  the  actual  fits,  if  they  supervene, 
may  be  the  second.  The  predispositon  to  eclampsia  in  the 
case  of  multiple  pregnancy,  and  the  great  improvement 
which  follows  emptying  the  uterus,  are  strongly  in  favor 
of  the  supposition  that  the  poison  is  produced  in  the  child. 
Another  observer  believes  that  the  disease  is  due  to  in- 
toxication by  poisonous  ferments  which  arise  in  the  pla- 
centa, a  supposition  which  immediately  suggests  the  fer- 
ments of  trophoblast  or  cancer. 

Now  in  the  early  stages  of  the  treatment  of  cancer  by 
trypsin,  before  the  importance  of  amylopsin  was  recog- 
nized by  Dr.  Beard,  symptoms  were  frequently  observed 
which  had  a  very  marked  resemblance  to  the  earHer  symp- 
toms of  eclampsia,  and  among  these  was  the  occurrence 
of  albumin  in  the  urine.  This  observation  seemed  to 
Dr.  Beard  to  afford  some  further  support  to  a  theory  of 
the  nature  of  eclampsia  which,  it  is  not  impossible,  may 
yet  be  verified.  The  theory^  is  that  in  the  case  of  eclamp- 
sia, and  in  the  case  of  the  treatment  of  cancer  by  trypsin 

^Encyclopcedia  Medica,  vol.  Ill,  p.  I74- 

*See  the  "Interlude  of  Cancer,"  by  Dr.  Beard,  Medical  Record, 
Feb.  2,  1907. 


298     THE  CONQUEST  OF  CANCER 

alone,  the  symptoms  are  due  to  one  and  the  same  cause — 
the  absorption  into  the  blood  of  products  of  dead  and  de- 
generating trophoblast.  Dr.  Beard  believes,  as  we  have 
seen,  that  the  normal  trophoblast  is  killed  at  the  critical 
period — the  seventh  week  in  man — when  the  pancreas  first 
begins  to  form  trypsin.  But,  as  we  may  remember,  the 
pancreas  of  a  human  fcetus  and  of  a  child  until  the  age 
of  one  year  produces  no  amylopsin — this  being  the  reason 
why  a  baby  cannot  digest  starch.  Dr.  Beard  believes, 
then,  that  it  is  the  amylopsin  produced  by  the  pancreas 
of  the  mother  which  completes  the  digestion  of  the  foetal 
trophoblast.  This  is  a  long  process,  for  remains  of  dead 
trophoblast  can  be  found  in  the  placenta  after  birth.  Says 
Dr.  Beard,  "In  normal  gestation,  if  anytliing  went  wrong 
with  the  maternal  pancreas  gland,  and  if  the  maternal 
supply  of  amylopsin  became  diminished,  or  ceased,  then 
serious  symptoms  were  bound  to  follow."^  To  my  ques- 
tion why,  if  this  theory  be  correct,  the  symptoms  of 
eclampsia  usually  appear  late  in  pregnancy,  whereas  the 
trophoblast  is  killed  as  early  as  the  seventh  week,  Dr. 
Beard  replied  that,  though  the  trophoblast  is  killed  at  the 
critical  period,  there  is  then  only  little  trypsin  being 
formed;  "later,  as  the  fcetus  grows  and  grows,  it  pro- 
duces more  trypsin,  and,  therefore,  more  products  of  its 
activity." 

Like  all  other  theories,  this  must  be  put  to  the  test  of 
experiment,  and  the  experiment  must  obviously  consist 
in  the  injection  of  active  amylopsin  in  cases  of  eclampsia. 
So  far  as  I  know,  at  the  time  of  writing,  amylopsin  has 
not  been  used  by  any  one  in  any  such  case.  The  disease, 
however,  is  terribly  common,  and  there  exists  no  specific 

^The  pancreas  is  found  to  be  seriously  damaged  in  these  cases, 
though  the  damage  is  not  pecuHar  to  this  organ. 


AMYLOPSIN  AND  ECLAMPSIA  299 

remedy  for  it.  Injection  of  amylopsin  is  without  the 
smallest  danger,  and  causes  very  little  local  disturbance, 
or  none  at  all.  Physicians  may,  therefore,  be  counselled 
to  make  observations  on  this  point,  for  it  is  not  impossible 
that  these  may  show  them  to  have  been  armed  by  Dr. 
Beard  with  the  true  specific  remedy  for  this  disease.  It 
is,  at  any  rate,  the  general  experience  of  the  physicians 
who  have  employed  amylopsin  in  the  treatment  of  cancer, 
that  it  does  control  the  constitutional  symptoms  which 
may  be  set  up  by  the  use  of  trypsin  alone  in  that  disease, 
and  the  resemblance  of  these  symptoms  to  those  of 
eclampsia  cannot  be  ignored,  especially  if  the  existence  of 
degenerating  trophoblast  in  the  pregnant  uterus  be  re- 
membered. 


PART  III— SOCIOLOGICAL 


CHAPTER  XX 

THE  POWERS  THAT  BE 

"They  take  to  criticising  me  a  little  more  in  the  Reviews, 
and  God  send  I  be  not  proud  of  their  abuse,  for  there  is  no 
hiding  the  fact  that  it  is  of  the  proper  old  drivelling  virulence 
with  which  God's  elect  have  in  all  ages  been  regaled." — From 
a  letter  of  Robert  Browning. 

"Yet  when  the  new  light  which  we  beg  for  shines  in  upon 
us,  there  be  who  envy  and  oppose,  if  it  come  not  first  in  at 
their  casements." — Milton's  Areopagitica. 

No  new  truths  required. — Proposed  motto  for  any  institu- 
tion. 

The  history  of  all  progress — whether  physical,  intellect- 
ual, moral,  social  or  artistic — is  a  history  of  revolt  against 
the  thing  that  is.  Involved  in  the  very  idea  of  advance 
is  the  supersession  of  what  is  already  established — wheth- 
er a  creed,  or  a  practice,  or  an  authority,  or  an  aesthetic 
canon.  The  new — which  may,  of  course,  be  worse  or  bet- 
ter than  the  old — is  known  in  biology  as  variation,  and 
variations  are  the  raw  material  of  all  organic  evolution. 
Those  that  endow  the  creatures  who  display  them  with 
fitness  for  life  are  selected  by  Natural  Selection,  while 
those  that  do  not  are  rejected.  Thus  progress  has  been 
effected. 

In  the  supra-sensible  world  the  same  law  holds.  All 
human  progress  has  been  effected  by  individuals,  by  indi- 
viduality, and  by  the  psychical  products  of  individuals: 

303 


304     THE  CONQUEST  OF  CANCER 

never  by  committees  or  crowds.  Every  truth  began  as 
a  heresy.  Institutions  imitate,  individuals  initiate ;  insti- 
tutions copy,  individuals  create.  But  just  as  in  the  realm 
of  organic  evolution,  so  in  the  realm  of  super-organic 
evolution,  the  good  is  the  enemy  of  the  better,  the  half- 
truth  of  the  whole  truth.  The  powers  that  be  set  their 
face  indifferently  against  everything  that  is  new,  whether 
it  be  good  or  bad,  an  improvement  or  a  deterioration. 
This  is  necessarily  so,  and  involves  no  moral  condemna- 
tion of  established  things.  Were  it  not  for  this  principle 
of  conservatism  or  orthodoxy,  which  in  the  organic  world 
is  called  heredity,  there  could  be  no  surety  for  the  per- 
sistence of  the  good ;  we  should  have  no  hold  at  all  upon 
what  our  fathers  have  won  for  us. 

But,  on  the  other  hand,  this  conservative  principle  has 
ever  and  inevitably  involved  the  temporary  postponement 
and  precariousness  of  the  new  that  is  better — the  worthy 
variation.  It  sometimes  remains  a  problem  for  the  biolo- 
gists to  understand  how  it  was  that  the  new  thing — such 
as,  say,  wings,  or  a  central  nervous  system — was  able' 
to  hold  its  place  while  it  was  in  an  immature  state.  It 
would  survive  in  virtue  of  its  survival  value  when  it 
was  sufficiently  well  developed  to  be  effective;  but  it 
must  have  had  a  hard  time  in  its  ineffective  youth,  when 
its  presence  embarrassed  rather  than  aided  its  possessor. 

And  it  is  profoundly  true  of  new  truths  or  new  ways 
of  thinking,  that  their  case  is  hard  in  the  early  days. 
The  founder  of  ethical  science  was  compelled  to  drink 
poison  on  the  ground  that  he  was  a  corrupter  of  youth. 
The  Supreme  Exemplar  of  the  ages  was  crucified  as  a 
blasphemer,  and  the  Florentine  monk  who  sought  to  re- 
form the  established  authority  which  called  itself  by  His 
name  was  burnt  at  the  stake.     Ever  the  way  of  trans- 


THE  POT\^RS  THAT  BE  305 

gressors — the  word  being  used  in  its  etymological  sense — 
is  hard.  They  cross  the  path  of  the  many  and  the  power- 
ful, and  must  pay  the  price  for  so  doing. 

Those  human  activities  which  are  concerned  with  the 
quest  of  truth,  and  which  Ave  call  philosophic  and  scien- 
tific, are  no  exception  to  the  rule.  The  powers  that  be 
seek  to  maintain  themselves  in  being;  it  is  not  in  the 
nature  of  things  that  they  should  do  otherwise.  The 
truth,  or  nearer  approximation  to  the  truth,  that  began  as 
a  heresy,  ends  as  a  superstition.  Socrates  was  poisoned, 
but  the  doctrines  of  his  pupil's  pupil  came  to  dominate 
Europe.  A  professorial  colleague  of  Galileo  declined  to 
look  through  his  newly  invented  occhialc,  or  telescope,  at 
the  moons  of  Jupiter,  because  they  were  not  mentioned 
by  Aristotle,  and  their  existence  was,  therefore,  unthink- 
able. The  ceaseless  persecution  to  which  the  great  as- 
tronomer and  physicist  was  subjected  had  its  origin  in 
the  resentment  which  he  excited  in  the  followers  of  Aris- 
totle— the  powers  that  were — by  his  experiment  of  drop- 
ping balls  of  various  weights  from  the  leaning  tower  of 
Pisa,  thereby  demonstrating  the  falsit}-  of  an  assertion 
made  by  their  master.  In  the  same  land  and  age,  Gior- 
dano Bruno,  the  first  philosopher  to  form  a  true  concep- 
tion of  the  nature  of  the  cosmos,  was  burnt  for  opinions 
which  are  now  familiar  truths ;  and,  in  our  own  time, 
when  the  author  of  the  doctrine  of  universal  evolution' 
died,  he  was  truly  described  in  the  Fortnightly  Review  as 
"him  whom  all  the  world  outside  the  walls  of  our  univer- 
sities mourns  and  honors  to-day." 

Conspicuous  and  exceedingly  important  among  the 
modern  powers  that  be  is  the  medical  profession,  and  it 
is  worth}'  of  note  that,  such  is  human  nature,  established 
authority  is  true  to  itself  in  the  realm  of  science  as  in 


S06     THE  CONQUEST  OF  CANCER 

the  realm  of  theology.  It  is  part  of  the  ideal  creed  of 
science  and  her  followers  that  there  is  no  authority  but 
truth ;  and  her  history,  as  she  rightly  insists,  is  the  history 
of  the  struggle  between  superstition  and  theological  au- 
thority, with  all  their  tremendous  power,  and  the  new 
truths  which,  in  the  beginning,  have  had  for  their  sup- 
port but  the  voice  of  one  man — and  the  unconquerable 
power  which  is  part  of  the  appanage  of  all  truth.  Lat- 
terly, however,  scientific  doctrines,  like  theological  doc- 
trines, have  become  established,  have  been  elevated  to 
the  rank  of  formal  creeds  and  accredited  dogmas ;  and 
the  principle  of  the  repudiation  of  authority,  which  was 
so  easy  of  acceptance  when  the  authority  was  extra- 
scientific,  has  become  complicated  by  the  emergence  of 
scientific  authority.  Hence,  since  the  days  when  scientific 
opinions,  instead  of  being  merely  the  teaching  of  this 
man  or  that,  first  became  established,  scientific  intolerance 
has  vied  even  with  theological  intolerance,  and  with  in- 
finitely less  excuse,  as  consideration  of  the  respective  as- 
sumptions of  science  and  theology  immediately  shows. 
Here  we  may  confine  ourselves  to  medical  and  surgical 
science,  and  to  those  recent  days  in  which  it  has  achieved 
such  great  triumphs. 

Anaesthesia  and  antisepsis,  with  all  that  this  last  im- 
plies, represent  the  two  great  achievements  of  the  medical 
sciences  in  the  last  century — or,  indeed,  in  any  century. 
Let  us  briefly  consider  their  history. 

In  the  domain  of  surgery  the  established  powers  were, 
of  course,  the  surgeons.  It  was  not  from  a  surgeon  that 
the  advance  came;  and  this  principle,  that  the  advance 
comes  not  from  the  powers  that  be,  but  from  without,  is 
illustrated  most  abundantly  before  and  after  the  discovery 
of  anaesthesia.     A  conspicuous  protagonist  of  the  em- 


THE  POWERS  THAT  BE  307 

ployment  of  ansesthetics  in  surgical  operations— though 
not  actually  the  first  man  to  make  such  employment— was 
Sir  James  Simpson,  of  Edinburgh.     He  was  not  a  sur- 
geon, but  an  obstetrician.     Even  in  his  own  department 
he  was  bitterly,  persistently,  and  all  but  successfully  op- 
posed by  the  powers  that  were,  while  they  were  keenly 
supported  by  the  clergy,  who  denounced  as  blasphemous 
and  impious  the  attempt  to  abrogate  the  curse  pronounced 
upon  Eve— "In  sorrow  shalt  thou  bring  forth."     These 
persons,  protesting  against  the  mitigation  of  pains  which 
they  could  never  be  called  upon  to  endure,  were  only 
silenced  when  Simpson,  obeying  the  injunction  to  "answer 
a  fool  according  to  his  folly,"  observed  that  the  Lord 
God  had  employed  anaesthesia  in  the  first  surgical  opera- 
tion on  record,  since  He  caused  a  "deep  sleep"  to  fall 
upon  Adam,  before  the  excision  of  the  rib  which  was 
converted  into  Eve.    As  for  the  surgeons,  their  hatred  of 
the  interloper  and  his  success  can  be  realized  only  by 
those  who  lived  in  Edinburgh  in  those  days,  or  have  heard 
of  it  from  those  who  did  so.     In  a  word,  the  introduction 
of  this  unspeakable  boon  to  all  mankind,  patients  and 
surgeons  alike,  was  opposed,  tooth  and  nail,  by  the  surgi- 
cal profession  of  the  day. 

But  let  us  turn  to  the  history,  more  remarkable  still, 
of  the  actual  pioneer  in  this  matter,  Dr.  W.  T.  G.  Mor- 
ton, of  Boston.  He  it  was  who,  in  1846,  after  plucky 
experiments  upon  himself — not  to  mention  his  favorite 
dog— gave  the  first  public  demonstration  of  surgical  an- 
aesthesia. He  was  then  only  a  medical  student.  He  is 
now  commemorated,  over  his  grave  near  Boston,  as  the 
"inventor  and  discoverer  of  anaesthetic  inhalation ;  before 
whom,  in  all  time,  surgery  was  agony,  by  whom  pain  in 
surgery  was  averted  and  annulled,  since  whom  science 


308     THE  CONQUEST  OF  CANCER 

has  control  of  pain."  But  what  were  the  facts  of  his  Hfe- 
time? 

He  was  beset  by  after  claimants,  one  of  whom  was 
proved  to  have  denounced  the  discovery  as  a  dangerous 
practice  for  months  after  Morton's  epoch-making  demon- 
stration. "No  one  unfamiliar  with  the  story  of  the  at- 
tempts to  rob  him  of  his  just  merits  through  twenty-one 
years  of  bitter  attack,  including  ten  years  of  vain  strug- 
gle with  the  government  for  even  a  most  modest  recom- 
pense, can  realize  at  tliis  day  the  weight  of  the  powers 
of  adversity  which  beset  his  course.  .  .  .  Having  spent 
a  very  considerable  fortune  to  introduce  his  discovery 
and  defend  himself  from  attack,  he  was  reduced  to  pov- 
erty. It  was  not  many  years  until  life  itself  was  quietly 
crushed  out  beneath  the  load.  The  discovery  of  surgical 
anaesthesia,  while  a  boon  to  the  world,  was  a  tragedy  to  its 
author  and  to  his  family :  .  .  .  his  life  was  the  one  single 
life  unblessed  by  what  was  to  others  blessing."  As  Dr. 
Weir  Mitchell  has  said, 

"We  took  the  gift  so  humbly,  simply  given, 
And  coldly  selfish — left  our  debt  to  Heaven." 

Though  this  magnificent  gift  to  that  generation,  to  ours, 
and  to  all  that  are  to  be,  could  not  be  refused,  at  least 
the  powers  that  were  could  wreak  their  vengeance  on 
the  giver,  and  he  died,  a  broken-hearted  man,  at  the  age 
of  forty-eight. 

Now  it  is  a  noteworthy  and  significant  fact  that  Prof. 
W.  J.  Morton,  whose  splendid  pioneer  work  in  America, 
begun  not  three  months  after  the  publication  of  Dr. 
Beard's  mouse  experiments,  has  been  of  inestimable  serv- 
ice in  furthering  the  treatment  of  cancer  by  ferments,  is 


THE  POWERS  THAT  BE  309 

the  son  of  the  great  pioneer  of  surgical  anaesthesia.  This 
is,  indeed,  as  it  should  be,  and  the  name  of  Morton  may 
go  down  doubly  honored  to  ages  yet  unborn. 

The  next  case  was  that  of  Pasteur  and  Lister.  The 
French  chemist  is,  of  course,  incomparably  the  greatest 
physician  of  all  time,  if  language  is  to  be  rightfully  em- 
ployed ;  but  he  was  not  a  member  of  the  medical  profes- 
sion. Properly,  he  was  a  chemist,  and  while  his  great 
chemical  teachers  encouraged  his  labors  in  that  field  they 
frowned  upon  his  excursions  into  biology — excursions 
which  led  him  yet  so  much  further  afield.  One  English 
surgeon,  now  Lord  Lister,  had  the  insight  and  the  courage 
to  realize  what  Pasteur's  work  signified  for  his,  and,  as 
in  the  case  of  Simpson,  the  magnificent  and  immeasurably 
beneficent  reform  which  he  inaugurated  was  virulently 
opposed  by  his  colleagues — the  powers  that  were.  We 
need  not  blame  them,  nor  ascribe  to  them  any  peculiar 
villainy  or  hatred  of  the  light.  They  were  merely  doing 
what  the  established  thing  always  has  done  in  all  ages, 
and  always  will  do  until  human  nature  has  become  angelic. 
When  I  was  a  student  in  Edinburgh  there  still  survived  a 
surgeon,  a  former  colleague  of  Lister  in  the  infirmary 
of  that  city,  who  had  opposed  the  great  reform,  and 
though  he  had  long  acepted  the  heterodoxy  (when  it 
had    become   orthodox)    we    still    knew    him    as    "dirty 

,"  and  handed  on  the  graceful  epithet  to  the  new 

generation.  But  as  in  the  case  of  Simpson,  and  as  in  all 
cases,  if  we  but  follow  them  to  the  end,  the  truth  and 
one  are  a  majority,  and  the  successors  of  the  men  who 
rejected  Lister  find  in  him  their  chief  pride.  "The  stone 
which  the  builders  rejected  is  become  the  head  of  the 
corner." 

For  the   facts  of  the  introduction  of  inoculation  for 


310     THE  CONQUEST  OF  CANCER 

smallpox  by  a  brave  woman,  Lady  Mary  Wortley  Mon- 
tagu, it  suffices  to  quote  from  one  of  her  own  letters : 

"1  am  patriot  enough  to  take  pains  to  bring  this  useful 
invention  into  fashion  in  England ;  and  I  should  not  fail 
to  write  to  some  of  our  doctors  very  particularly  about  it, 
if  I  knew  any  one  of  them  that  I  thought  had  virtue 
enough  to  destroy  such  a  considerable  branch  of  their 
revenue  for  the  good  of  mankind.  But  that  distemper 
is  too  beneficial  to  them  not  to  expose  to  all  their  resent- 
ment the  hardy  wight  that  should  undertake  to  put  an 
end  to  it.  Perhaps,  if  I  live  to  return,  I  may,  however, 
have  courage  to  war  with  them. 

"The  faculty  rose  in  arms  to  a  man,  foretelling  failure 
and  the  most  disastrous  consequences ;  the  clergy  descant- 
ed from  their  pulpits  on  the  impiety  of  thus  seeking  to 
take  events  out  of  the  hand  of  Providence ;  and  the  com- 
mon people  were  taught  to  hoot  at  an  unnatural  mother 
who  had  risked  the  lives  of  her  own  children." 

Inoculation  was,  of  course,  superseded  by  vaccination, 
and  Edward  Jenner's  paper  announcing  his  discovery, 
one  of  the  most  beneficent  of  all  time,  was  refused  by 
the  Royal  Society. 

A  still  more  recent  case  is  that  of  hypnotism  or  hypnotic 
suggestion  for  therapeutic  purposes,  which  was  so  bitterly 
fought,  it  is  interesting  to  note,  by  a  former  editor  of  the 
British  Medical  Journal^  and  which  is  still  practically  ta- 
boo in  Great  Britain,  notwithstanding  the  fact  that 
James  Braid  was  a  Manchester  surgeon.  In  this  con- 
nection the  reader  who  refers  to  the  issues  of  the  General 
Practitioner  which  contain  the  first  reports  of  the  compe- 
tent pancreatic  treatment  of  cancer  in  Great  Britain  will 
find  therein  some  recent  records  of  the  results  of  thera- 
peutic suggestion — records   which  would  not  be  worth 


THE  POWERS  THAT  BE  311 

printing  on  the  Continent,  so  commonplace  would  they 
be,  but  which  in  this  country  cannot  even  find  publica- 
tion in  the  "authoritative"  medical  journals. 

And  the  latest  development  in  therapeutics  and  pathol- 
ogy is  no  exception  to  the  rule.  Just  as  the  battle  for 
surgical  anaesthesia  was  fought,  against  the  surgeons,  by- 
one  who  was  not  a  surgeon ;  just  as  it  was  left  to  a  chemist 
to  teach  physicians  tlie  nature  of  infectious  disease,  and 
surgeons  the  nature  of  inflammation  and  the  "surgical" 
fevers,  so  it  was  left  to  an  embryologist  to  discover  the 
nature  of  cancer  and  point  to  the  natural  means  whereby 
it  may  be  cured  and  can  constantly  be  relieved. 

All  medical  means  of  treating  cancer  having  been  found 
futile,  its  therapeutics  had  been  entirely  relegated  to  the 
surgeons,  while  the  problem  of  its  nature  was,  of  course, 
the  business  of  the  pathologist,  whose  science  concerns 
itself  with  the  nature  of  disease  in  general  and  diseases  in 
oarticular.  There  is  no  surgeon  worth  considering  ex- 
cept him  who  is  also  a  pathologist ;  the  surgeon,  as  such, 
is  obviously  no  more  than  a  highly-trained  and  responsible 
artisan.  Among  the  great  surgeon-pathologists  will  al- 
ways be  counted  Sir  James  Paget,  one  of  the  glories  of 
English  science.  His  insight  enabled  him  to  perceive,  at 
a  comparatively  early  date,  that  a  cancer  is  an  imitation- 
tissue;  but  this  dictum,  the  truth  of  which  will  soon  be 
recognized,  has  been  too  frequently  ignored  by  his  suc- 
cessors. Apart  from  this,  the  contributions  of  the  sur- 
geon-pathologists to  this  problem  have  been  of  scant  im- 
portance, dealing  rather  with  the  manner  in  which  the 
disease  spreads  than  with  its  nature.  ]\Iuch  more  im- 
portant than  any  work  of  the  surgeons  were  the  labors 
of  the  great  pathologist,  Rudolf  \"irchow,  of  Berlin,  who 
taught  us  to  describe  and  estimate  all  disease-processes 


312     THE  CONQUEST  OF  CANCER 

in  terms  of  the  cell.  Malignant  disease,  in  all  its  forms, 
is  very  evidently  a  problem  in  what  A'irchow  calls  ''cel- 
lular pathology" ;  but,  unfortunately,  the  efforts  of  his 
followers  have  been  directed — exclusively  directed,  one 
may  say — to  the  description  of  the  various  cell-forms 
found  in  various  tumors,  the  dictum  of  Paget  that  cancer 
is  an  imitation-tissue  being  forgotten.  This  dictum  in- 
volves, of  course,  the  truth  that  the  various  appearances 
found  in  various  tumors  are  essentially  accidental  and 
superficial.  Lately,  indeed,  Ehrlich  and  others  have  shown 
by  inoculation  through  successive  mice  that  cancer  and 
sarcoma — long  supposed  to  be  fundamentally  distinct  va- 
rieties of  malignant  tumor — may  actually  be  converted 
one  into  the  other. 

Needless  to  say,  the  work  of  Pasteur  seemed  to  offer 
hope  of  solving  the  cancer  problem.  The  disease  might 
be  due  to  an  infection  by  some  germ  or  microbe,  and 
scores  of  such  have  been  "discovered,"  each  in  its  turn  to 
be  discredited  by  further  inquiry.  There  seemed  to  be 
a  resemblance  between  the  multiplication  of  cells  in  a 
malignant  tumor  and  that  which  is  known  to  occur  in 
inflammations,  which  are  commonly  due  to  the  influence 
of  microbes,  as  we  have  already  seen.  In  certain  of  the 
lower  animals  a  kind  of  growth,  not  unlike  a  malignant 
tumor,  was  shown  to  be  due  to  the  presence  of  parasites 
called  coccidia,  and  the  phenomena  of  coccidiosis,  as  the 
disease  is  called,  seemed  to  supply  a  link  between  those 
of  ordinary  inflammation  and  those  of  malignant  growths. 

Further,  the  supposed  discovery  of  cancer  germs  has 
led  to  the  making  of  antitoxins  or  serums  credited  with 
the  power  of  curing  the  disease.  Notable  among  these  is 
the  cancer  serum  of  the  Parisian  surgeon,  Doyen,  but 
it  has  been  proved  a  failure.    The  bacteriologists,  we  may 


THE  POWERS  THAT  BE  313 

say,  scarcely  count  among  the  powers  that  be — or  were — 
in  regard  to  cancer. 

These  powers  are  the  surgeons,  the  pathologists  in  gen- 
eral, and  those  workers  specially  employed  by  two  or  three 
bodies  in  this  country,  and  by  others  elsewhere,  for  the 
prosecution  of  work  at  the  problem. 

The  general  attitude  of  the  surgeons  may  be  easily  de- 
scribed. Rightly  enough,  as  it  seemed,  they  insisted  that 
the  one  remedy  for  cancer  is  early  operation,  and  they 
deplored  all  other  methods  as  tending  to  lead  to  waste 
of  priceless  time.  They  were  able  to  show  that,  when 
they  were  given  the  best  chance,  they  could,  on  rare  occa- 
sions, perform  radical  cures  of  true  cancers,  and,  after 
long  and  varied  collision  with  other  methods  of  treatment, 
the  vast  majority  of  which  were  originated  and  prose- 
cuted as  means  of  making  money,  the  surgeons  might 
well  be  excused,  until  a  comparatively  recent  date,  for 
adopting  a  consistently  contemptuous  attitude  toward  all 
means  of  treatment  other  than  the  knife. 

The  pathologists  in  general,  and  the  instituted  research- 
ers, continued  to  study  the  disease  along  the  usual  lines, 
describing  the  microscopic  characters  of  various  tumors, 
collecting  statistics,  and  so  forth.  One  notable  advance, 
that  might  in  time  have  led  haphazard  to  the  truth,  was 
made  by  Professor  Rudolf  Jensen,  of  Copenhagen,  who 
succeeded  in  inoculating  mice  with  portions  of  cancerous 
tumors  which  had  originated  in  other  mice  of  the  same 
species.  The  discovery  of  this  possibility  offered  a  wide 
field  for  experiment,  the  inoculated  tumors  being  observed 
and  their  behavior  noted.  This  it  was,  as  we  have  seen, 
that  led  to  the  remarkable  recognition  of  the  possibility 
of  transforming  one  kind  of  malignant  tumor  into  an- 
other, hitherto  supposed  to  be  unchangeably  different. 


314^  THE  CONQUEST  OF  CANCER 

This  discovery  is  of  interest  because  of  its  entire  conso- 
nance with  the  theory  of  Dr.  Beard,  which  sweeps  aside 
all  the  superficial  differences  between  malignant  tumors, 
over  which  the  pathologists  have  wasted  so  many  decades, 
and  declares  their  fundamental  identity.  All  the  differ- 
ences are  mere  masquerade,  and  nothing  more. 

Also,  the  observation  that  a  mouse  cancer  cannot  be 
inoculated  successfully  into  a  dog,  or  into  a  rat,  or  even 
into  any  mouse  but  one  of  the  same  species,  if  not  of  the 
same  variety,  is  of  interest  because  it  consorts  entirely 
with  the  theory  of  Dr.  Beard.  Apart  from  that  theory  it 
was  a  striking  fact,  but  it  had  not  led  any  one  to  the  truth 
— i.e.  the  trophoblastic  theory — which  was,  indeed,  pub- 
lished by  Dr.  Beard  long  before  the  discovery  that  cancer 
could  be  inoculated  at  all. 

So  much  for  what  the  powers  that  were  had  accom- 
plished. There  was  a  large  mass  of  work,  the  signifi- 
cance of  which  can  now  be  appreciated,  but  all  the  work- 
ers were  groping  in  the  dark.  None  of  them  had  the  key, 
all  were  on  wrong  tracks.  Hypothesis  is  invaluable  in 
science,  as  Bacon  did  not  recognize  in  his  Novum  Or- 
ganuni,  but  as  has  been  abundantly  recognized  since  his 
day.  The  powers  that  were  had  either  no  hypothesis,  or 
wrong  ones,  and,  if  the  past  history  of  science  is  any 
guide,  they  might  have  continued  to  collect  facts  until 
the  "last  syllable  of  recorded  time,"  without  arriving  any 
nearer  to  the  truth.  Your  Dalton  or  Newton  or  Coperni- 
cus or  Darwin  or  Pasteur  is  not  only  an  observer :  he  has 
a  creative  mind.  His  scientific  imagination  provides  him 
(it  is  always  him,  never  them)  with  an  idea,  a  true  hy- 
pothesis, and  zuith  this  clue  he  sets  to  work  to  collect  the 
facts  which  ultimately  establish  his  triumph.  When  a 
scientific  committee,  such  as  that  of  the  Imperial  Cancer 


THE  POWERS  THAT  BE  S15 

Research  Fund,  informs  us  that,  in  its  study  of  a  subject, 
it  is  studiously  avoiding  all  hypotheses — adding  a  sneer 
at  those  who  do  not  do  likewise — we  may  be  quite  sure 
that  it  will  accomplish  nothing,  or  nothing  but  the  accu- 
mulation of  an  unassorted  heap  of  bricks,  which  is  not 
the  same  thing  as  architecture.  And  no  matter  how 
sound  and  large  and  many  the  bricks,  they  will  never 
arrange  themselves  into  a  tower  foursquare  to  all  the 
winds  that  blow.  That  is  an  act  of  mind,  and  of  mind 
alone. 

So  when  Dr.  Beard  had  the  temerity  to  advance  the 
hypothesis  of  the  trophoblastic  nature  of  cancer,  sug- 
gested by  embryological  facts  known  only  to  him  and 
to  the  very  few  specialists  who  had  studied  his  mono- 
graphs of  the  past  twenty  years,  the  powers  that  were 
— and  are  not — were  as  indignant  and  obstructive  as  such 
powers  have  always  been  since  the  beginning,  and  will 
be  until  men  learn  that  there  is  no  authority  but  truth. 
What  on  earth  could  a  complete  outsider  know  about 
cancer?  He  had  never  seen  a  case  of  the  disease,  and  had 
not  even  had  a  complete  medical  training.  He  was  "not 
even  a  medical  man,"  said  a  prominent  scientific  journal, 
which  might  be  thought  to  have  heard  of  Pasteur.  He 
was  a  biologist,  and  it  no  more  occurred  to  the  powers 
that  were,  and  soon  will  be  no  more,  that  the  problem 
of  cancer  might  be  a  biological  problem,  than  it  occurred 
to  their  predecessors  that  inflammation  might  be  a  bac- 
teriological problem.  This  matter  was  best  left  to  those 
who  had  spent  their  lives  in  its  study,  who  saw  and  han- 
dled and  excised  and  made  sections  of  cancers  every 
day. 

Dr.  Beard's  theory  might  be  plausible  enough — but  he 


316     THE  CONQUEST  OF  CANCER 

had  "no  evidence."  The  truth,  of  course,  was  that  he 
had  abundance  of  evidence  for  a  man  of  his  knowledge 
and  genius,  but  it  was  of  a  kind  which  the  estabhshed 
powers  had  no  means  of  estimating.  It  would  have 
taken  them  a  long  time  even  to  acquire  an  acquaintance 
with  the  necessary  terminology.  That  not  one  surgeon 
in  ten  thousand  should  ever  have  heard  of  trophoblast 
is  not  in  the  least  remarkable  or  disgraceful :  the  surgeon 
who  undertook  a  systematic  study  of  embryology  could 
not  be  as  good  a  surgeon  as  one  who  stuck  to  his  last. 
But  what  adjective  shall  be  applied  to  condemnation 
without  understanding  ? 

When  the  practicing  physician  or  surgeon  uses  the 
phrase  "no  evidence,"  he  usually  means  "no  clinical  evi- 
dence." To  him  it  is  the  same  thing:  but  it  is  not  the 
same  thing.  And  obviously  there  could  be  no  clinical 
evidence  until  the  matter  had  been  put  to  a  clinical  test; 
and  this  was  impossible  until  Dr.  Beard  had  gained  the 
help  of  some  one  with  clinical  opportunities.  "Not  even 
a  medical  man"  himself,  he  could  not  adopt  the  obvious 
means  of  treating  a  patient  or  patients  with  trypsin,  and 
publishing  the  results.  He  could  only  state  his  theory 
with  the  embryological  evidence  which,  being  published 
in  medical  papers,  not  read  by  embryologists,  probably 
not  a  single  one  of  all  his  readers  ever  appreciated — any 
more  than,  for  instance,  the  present  writer  did. 

Though  I  was  myself  a  pupil  of  Dr.  Beard's,  and  had 
read  two  of  his  monographs  while  I  was  a  student,  I 
cannot  for  a  moment  pretend  that  his  views  had  ever 
specially  gained  my  attention,  deeply  interested  though 
I  was  in  the  problem  of  cancer.  For  me,  as  for  every 
one  not  at  once  an  embryologist  and  a  student  of  Dr. 
Beard's  contributions  to  that  science,  there  was  "no  evi- 


THE  POWERS  THAT  BE  317 

dence."     But  the  case  was  changed  when  he  published, 
in  the  British  Medical  Journal  for  January  20,  1906,  his 
brief  prehminarv  note  on  "The  Action  of  Trypsin  on 
the  Living  Cells'  of  Jensen's  Mouse  Tumor."     That  was 
published,  as  usual,  on  the  Friday  preceding  the  Satur- 
day which  gave  its  date  to  the  number  of  the  journal  in 
question,  and  I  read  it  with  bated  breath  on  that  day. 
In  the  evening,  as  I  perhaps  may  be  excused  for  recall- 
ing, I  went  to  hear  Prof.  J.  J.  Thomson  deliver  one  of 
his  wonderful  Friday  evening  discourses  at  the  Royal 
Institution,   and   I  can  well   remember,   on  leaving  the 
famous  theater,  my  amazement  at  realizing  that  I,  an 
inveterate  lecture  lover,  deeply  interested  in  the  lecturer 
and  his  subject,  and  accustomed  to  listen  assiduously  on 
such  occasions,  could  not  recall  one  single  statement  or 
conjure  up  the  picture  of  one  single  experiment— if  state- 
ments and  experiments  there  were,  as  I  should  not  care 
to  deny. 

Could  there  be  some  flaw  in  the  work?  The  cancer 
was  certainly  deadly,  for  it  was  known  to  have  killed 
thousands  af  mice.  Both  Dr.  Beard  himself,  and  the 
gentleman  v/ho,  holding  a  vivisection  license,  made  the 
inoculations,  were  known  to  me  personally:  it  was  im- 
possible to  question  their  good  faith.  The  untreated 
mice  had  died.  The  tumors  in  the  treated  mice  were 
actively  growing  when  the  injection  of  trypsin  was  be- 
gun. The  remedy  was  not  chosen  haphazard,  but  was 
indicated  by  a  theory  of  singular  simplicity  and  com- 
pleteness. Microscopic  examination  of  the  tumor-re- 
mains in  the  case  of  the  treated  mice  confirmed  the  clin- 
ical evidence  That  the  treated  mice  lived  and  the  others 
died  was  an  observation  not  of  a  kind  that  admitted  dif- 
ference of  opinion,  or  could  be  explained  away  as  due  to 


318     THE  CONQUEST  OF  CANCER 

the  lively  faith  of  a  sanguine  experimenter.  If  mice, 
why  not  men  ?  Trypsin  one  had  heard  of  in  physiological 
classes  as  the  most  powerful  ferment  of  proteid  food- 
stuffs and  as  the  chief  product  of  the  normal  pancreas. 
Doctors  had  given  it  to  their  patients  in  the  form  of 
liquor  pancrcaticus,  pancreatic  powders  and  so  on,  for 
many  years.  Had  the  problem  of  cancer  been  solved? 
With  such  thoughts  surging  and  resurging  through  one's 
head,  even  the  corpuscular  theory  of  matter,  expounded 
by  its  author,  could  scarcely  expect  a  hearing. 

Plainly  one  had  to  do  what  doubtless  all  the  surgeons 
were  doing — write  to  Dr.  Beard  and  obtain  access  to  his 
previous  contributions  to  the  subject.  The  experiments 
were  to  be  repeated  and  amplified  by  him,  and  of  course 
they  would  furnish  work  for  all  the  workers  at  the  sub- 
ject for  some  time  to  come ;  but  meanwhile  one  must  at 
least  look  into  the  basis  of  a  theory  that  had  led  to  experi- 
mental results  so  sensational  and  apparently  so  signifi- 
cant. Naturally  enough,  it  was  not  long  before  I  referred 
to  Dr.  Beard's  work  in  the  "Scientific  Notes"  which  I 
contribute  to  the  Pall  Mall  Gazette,  and  my  comments 
appeared  there  on  the  9th  of  February,  1906.  Those 
notes  had  their  result  in  a  case  or  two,  and  greatly  pro- 
longed at  least  one  valuable  life.  But  otherwise  nothing 
happened.  There  were  no  leading  articles  in  the  medical 
papers,  and  little  or  no  correspondence  on  the  subject. 
Apparently  every  one  of  the  readers  of  the  25,000  copies 
or  so  that  are  printed  of  each  number  of  the  British  Med- 
ical  Journal  had  accidentally  turned  over  two  pages  in- 
stead of  one  just  at  that  place. 

Further    inquiry    into    the    literature    of    the    subject 

seemed  to  show  clearly  enough  that  Dr.  Beard  was  on  the 

.right  track.     There  was  something  that  promised  well 


THE  POWERS  THAT  BE  319 

in  the  mere  fact  that  all  his  work  was  so  entirely  unre- 
lated to  all  previous  work  at  the  subject — the  failure  of 
which  all  the  world  knew.  Therefore  it  appeared  de- 
sirable to  insure  that  an  American  hearing  should  be  ob- 
tained for  his  views  without  delay,  this  being  a  matter 
of  life  and  death;  and  an  article  of  mine  on  the  subject 
was  published  in  Harper's  Weekly  for  March  3,  where  I 
knew  that  it  would  reach  a  large  audience,  including,  as 
my  previous  experience  had  shown,  not  a  few  capable 
of  taking  not  only  a  serious  but  also  an  active  and  effect- 
ive interest  in  any  subject  that  seemed  worthy  of  it. 
Only  a  week  or  two  later.  Prof.  Morton  of  New  York,  in 
consultation  with  Dr.  Beard  himself,  and  with  Messrs. 
Fairchild  Bros.  &  Foster  of  that  city,  long  known  as 
the  chief  students  of  the  ferments  and  their  ways,  began 
his  series  of  trials. 

There  was  everything  in  Dr.  Beard's  favor  except  the 
one  damning  fact  that  he  was  not  one  of  the  powers  that 
be.  Had  he  been  an  official  and  paid  researcher,  au- 
thorized by  his  appointment  to  frame  hypotheses  or  con- 
duct experiments  regarding  cancer,  his  results  could 
scarcely  have  failed  to  receive  as  much  attention  as  the 
official  digest  of  sterile  statistics  or  what  not.  On  the 
other  hand,  he  had  published  all  he  knew  in  scientific 
organs  of  the  highest  repute.  His  own  record  was  known 
to  all,  and  his  status  as  an  embryologist  in  one  of  the 
greatest  medical  schools  in  the  world.  He  had  no  secret, 
no  practice  to  augment,  no  fees  to  receive,  nothing  but 
honor  or  dishonor,  according  as  he  was  right  or  wrong ; 
and  he  had  burned  his  boats,  like  his  mighty  peers  before 
him.  Only  he  was  not  a  pathologist,  nor  a  surgeon,  "not 
even  a  medical  man,"  or  the  holder  of  a  medical  degree ; 
and  his  work  had  been  done  on  his  own  dining-room 


320     THE  CONQUEST  OF  CANCER 

table  in  his  spare  time,  and  with  material  and  a  micro- 
scope which  he  had  not  taken  the  precaution  of  having 
paid  for  by  a  fund.  He  was  just  a  servant  of  Truth,  in 
her  pay  alone,  his  reward  the  hope  or  the  realization  of 
finding  her.  In  a  word,  he  was  not  one  of  the  powers 
that  be. 

These,  then,  fell  upon  him.  They  began  by  publishing 
in  the  British  Medical  Journal  a  statement  to  the  effect 
that  he  had  not  had  their  permission  to  describe  his  ex- 
periments as  having  been  conducted — as  they  were — in 
the  laboratory  of  the  Royal  College  of  Surgeons  of  Edin- 
burgh. (They  had  to  be  conducted  there,  owing  to  the 
occurrence  of  so-called  "vivisection"  in  their  first  stage.) 
For  the  rest  they  ignored  him.  Without  their  help  his 
proposed  treatment  could  be  applied  to  no  human  cases. 
In  the  course  of  ten  months  some  thirty  doctors  in  all  in 
Great  Britain  wrote  to  him  concerning  this  subject. 
Among  them  was  not  one  writing  as  the  official  repre- 
sentative of  any  cancer  hospital  or  any  hospital  at  all. 
We  may  observe  that  in  this  country  some  thirty  thou- 
sand persons  die  of  cancer  every  year.  Still,  thirty  doc- 
tors did  write  to  Dr.  Beard — one  for  every  thousand 
deaths  from  cancer  per  annum. 

Week  by  week  the  medical  papers  in  this  country  ap-, 
peared  without  any  record  of  cases  treated  by  trypsin. 
Successful  results  would  obviously  have  been  important:' 
no  less  important,  though  in  another  fashion,  w^ould  have' 
been  unsuccessful  results.  None  appeared,  successful  or' 
unsuccessful,  though  week  followed  week  and  month  fol- 
lowed month.  So  early  as  August  of  last  year  I  could 
have  published  in  the  Fortnightly  Review  an  article  which; 
the  editor  so  far  honored  me  with  his  confidence  as  to' 
promise  to  print.     But  though  I  had  myself  seen  astound- 


THE  POWERS  THAT  BE  321 

ing  things  in  a  case  at  Leytonstone,  treated  with  scru- 
pulous and  admirable  skill  by  Dr.  Bonnefin,  I  did  not 
dare.  The  responsibility  seemed  too  great,  and  my  cour- 
age failed  me,  as  I  deeply  regret  to  admit.  The  only 
excuse  can  be  that  there  was  then  no  clinical  evidence 
of  such  a  kind  and  extent  as  adequately  to  support  the 
theory ;  and  the  kind  of  evidence  upon  which  it  was  based 
could  not  have  been  properly  presented  within  the  limits 
of  a  review  article.  So  I  delayed,  doubtless  thereby  earn- 
ing wholly  undeserved  credit  for  the  exhibition  of  "scien- 
tific caution,"  which  is  occasionally  what  it  purports  to 
be,  but  is  more  often  cowardice,  or  stupidity,  or  both. 
Meanwhile  I  heard  from  Prof.  Morton  that  he  was  get- 
ting results. 

Then  Prof.  IMorton  sent  me  an  advance  copy  of  his 
report,  which  appeared  a  few  days  later  in  the  New  York 
Medical  Record  for  December  8,  1906.  A  case  of  cure 
had  been  reported  in  the  same  journal  a  fortnight  before, 
and  in  the  issue  which  was  to  contain  Prof.  ]\Iorton's 
results  other  results  were  also  to  appear.  I  cast  to  the 
winds  the  so-called  "caution"  which  I  have  already  more 
truthfully  described,  and  published  a  signed  discussion 
of  the  matter  in  the  Pall  Mall  Gazette  for  December  10. 
Perhaps  one  of  the  most  noteworthy  facts  that  almost 
immediately  followed  was  the  receipt  of  courteous  letters 
from  the  respective  editors  of  notable  reviews  on  both 
sides  of  the  Atlantic — after  the  publication  of  Prof.  ^lor- 
ton's  report,  be  it  remembered — in  which  each  referred 
to  an  unnamed  adviser  who  was  looking  closely  into  the 
matter  for  him,  and  had  advised  him  not  to  publish  my 
article,  which  in  each  case  had  been  accepted  beforehand, 
and  in  one  case  had  even  been  paid  for.  Now  these  two 
gentlemen,  as  we  now  see,  knew  nothing  about  the  sub- 


322     THE  CONQUEST  OF  CANCER 

ject.  But  they  were  actually  prepared  to  take,  and  did 
take,  the  grave  responsibility  of  arresting  the  publication 
of  statements  which  might,  at  any  rate,  lead  to  the 
saving  of  valuable  human  lives.  Doubtless  their  advice, 
being  followed,  did  affect  the  consignment  to  the  tomb 
of  not  a  few  who  might  be  alive  and  well,  or  at  least  com- 
fortable, to-day,  but  who  were  consequently  left  to  their 
horrible  fate.  When  they  gave  their  advice,  the  cases  of 
Dr.  Rice,  Prof.  Morton,  Dr.  Cleaves,  and  Dr.  Golley — 
amounting  to  thirty-four  in  all — ^had  already  been  pub- 
lished. It  is  scarcely  credible  that,  giving  such  advice, 
they  had  acquainted  themselves  with  the  records  of  these 
cases ;  and  if  they  dared  to  give  such  advice  without  doing 
so,  what  decent  word  shall  be  spoken  of  them? 

The  subsequent  behavior  of  the  powers  that  be  may 
conveniently  be  discussed  under  various  headings,  and 
we  may  begin  with  the  medical  press  in  Great  Britain. 
Dr.  Beard  being  an  Englishman,  working  in  Great  Brit- 
ain, it  was,  of  course,  in  the  prophet's  own  country  that 
these  facts  were  observed.  Until  this  present  I  have 
made  no  reply,  except  in  the  recent  Observer  letter,  to 
any  attacks  in  the  medical  press,  it  being  more  convenient 
to  defer  brushing  the  mud  off  one's  clothes  until  it  is  dry. 
I  write  now  without  any  grudge  against  individuals,  since 
I  am  happily  unacquainted  with  the  names  of  all  but  one 
of  the  writers  to  whom  I  shall  refer.  My  quarrel  is  with 
institutions. 

A  paper  called  The  Medical  Press  and  Circular,  the 
motto  of  which  is  "Salus  Populi  Suprema  Lex,"  con- 
formed to  that  great  principle  by  publishing  (December 
19,  1906)  as  its  leading  article  an  insolent  attack  upon 
myself,  observing  that  practitioners  were  in  no  need  of 
Dr.  Saleeby's  help  on  this  subject,  "having  acquired  their 


THE  POWERS  THAT  BE  323 

information  where  that  writer  has  presumably  failed  to 
look  for  his,  namely,  the  current  issues  of  medical  period- 
icals and  recently  published  books  on  the  subject,"  and 
that  "the  hollowness  and  futility  of  the  whole  business 
was  exposed  by  interviews  with  cancer  hospital  authori- 
ties, by  which  it  was  revealed  that  trypsin  had  been  tried 
both  at  the  Middlesex  Hospital  and  at  the  Cancer  Hos- 
pital, and  had  proved  disappointing  in  their  hands."  We 
know  now  what  manner  of  fatal  farce  these  trials  were. 
The  writer  of  this  leading  article — leading  all  who  be- 
lieved it  on  the  road  to  death — warmed  to  his  work,  and 
concluded  his  exhibition  of  audacious  and  maleficent 
ignorance  by  asking  me  for  an  "ample  apology."  It  is 
something  to  have  genius,  if  it  be  only  a  genius  for 
effrontery.  Properly,  apology  means  defense,  and  as  this 
book  constitutes,  among  other  things,  a  defense  of  my 
action  in  this  matter,  I  submit  it  to  the  Medical  Press 
and  Circular  as  the  "ample  apology"  for  which  it  asked. 

On  March  20,  1907,  the  same  journal  took  the  oppor- 
tunity furnished  by  an  article  published  in  New  York  in 
criticism  of  one  case  of  Prof.  Morton's  twenty-nine  to 
say  that  the  evidence  on  which  I  relied  for  my  "extrava- 
gant statements  was  easily  seen  to  be  insufficient,  and  in 
the  light  of  further  information  has  vanished  altogether." 
The  last  two  words,  monstrously  untrue,  lead  me  to  hope 
that  the  writer  was  also  the  writer  of  the  previous  article. 
One  such  contributor  is  enough  for  any  paper.  Such,  at 
any  rate,  was  the  contribution  of  this  journal  to  that 
safety  of  the  people  which  it  regards  as  the  supreme  law. 
One  wonders  how  many  patients  were  killed  by  cancer 
whom  its  readers  were  dissuaded  from  treating  by  the 
pancreatic  ferments. 

I  have  referred  elsewhere  to  the  ignorance  which  has 


SM  THE  CONQUEST  OF  CANCER 

prevented  our  critics  in  any  instance  in  all  this  time  from 
advancing  the  excellent  argument  as  to  the  (supposed) 
development  of  anti-trypsin.  Here  I  may  briefly  note 
the  following  sentence  taken  from  the  Medical  Press  and 
Circular's  review  of  Dr.  Shaw-Mackenzie's  book,  else- 
where referred  to :  "How  many  physicians  and  sur- 
geons e.g.  ever  heard  of  trypsin  before  the  author  .  .  . 
proved  its  therapeutic  value,  besides  showing  its  action 
on  glycogen?"^  As  we  have  seen  elsewhere,  no  one 
whose  knowledge  of  the  ferments  could  cover  a  visiting- 
card  could  possibly  imagine  that  trypsin  had  any  action 
on  glycogen.  This  is  the  kind  of  knowledge  which  has 
set  itself  to  criticise  Dr.  Beard,  and  with  this  citation  the 
Medical  Press  and  Circular  may  be  dismissed.  I  will  not 
ask  it  for  an  "ample  apology,"  but  I  will  watch  its  future 
attitude  on  this  matter  with  deep  interest,  and  will  discuss 
it  at  my  convenience.- 

The  most  prominent  of  our  medical  monthlies  is  the 
Practitioner.  In  its  issue  of  February,  1907  (p.  289), 
this  paper  printed  an  editorial  article  which  said,  speak- 
ing of  trypsin :  "To  vaunt  it  as  a  cure  before  anything 
at  all  like  a  cure  has  been  achieved  is  a  crime  against 
mankind."  This  three  months  after  the  various  Amer- 
ican reports  had  been  printed.  The  reader  will  judge  as 
to  who,  in  this  matter,  have  been  guilty  of  a  "crime 
against  mankind."  The  article  also  contains  various  re- 
marks about  Dr.  Beard,  which  suggested  to  me  the  quo- 
tation from  Robert  Browning  that  stands  at  the  head  of 

^This  absurd  sentence  is  still  being  quoted  in  advertisements 
"both  in  the  Medical  Press  and  Circular  and  the  British  Medical 
Journal. 

^Meanwhile  its  publication  of  a  favorable  case  <Oct.  2,  1907) 
may  be  welcomed. 


THE  POWERS  THAT  BE  325 

this  chapter.  The  writer,  palpably  as  ignorant  of  the 
elements  of  the  subject  as  the  table  on  which  I  write, 
referred  to  Dr.  Beard  as  a  "highly  scientific  person"  and 
a  "cancer  crank."  Since  Dr.  Beard  is  not  a  medical  man, 
and  has  received  no  fee  from  any  one  for  his  prompt 
and  priceless  and  unfailing  advice  in  numberless  cases, 
he  could  not  be  described  as  a  "cancer  quack,"  but  the 
nearest  phrase  to  that  was  employed.  Not  that  many 
cancer  quacks,  many  of  them  with  high  "qualifications," 
have  not  abounded  in  this  business.  Those  who  have  writ- 
ten and  promulgated  all  the  malignant  nonsense  which 
has  delayed  the  control  of  this  malignant  disease  for 
nearly  two  years  past  have  earned  the  title  of  cancer 
quacks  a  thousandfold  more  abundantly  than  the  fools 
and  knaves  without  "qualifications"  or  degrees  who  have 
been  so  stigmatized  in  the  past. 

Nature  is  not  a  medical  journal,  but  the  leading  scien- 
tific journal  in  this  country.  It  published  (December 
20,  1906)  an  adverse  comment  on  my  Pall  Mall  Gazette 
article,  and  in  its  reply  to  the  letter  which  its  remarks 
drew  from  Dr.  Beard  stated  that  "the  pancreatic  enzymes 
must  be  injected  into  the  neighborhood  of  the  growth  or 
used  locally;  how,  then,  could  the  secondary  growths  in 
internal  organs  be  attacked?  Until  this  can  be  done,  no 
cure  for  cancer  will  have  been  obtained."  Dr.  Beard's 
second  letter,  correcting  this  most  important  and  in- 
excusable error,  was  not  inserted,  and  the  statement  was 
allowed  to  stand. 

The  Hospital  (January  26,  1907)  reproved  me  for  my 
Pall  Mall  Gazette  article.  It  said,  of  Prof.  Morton's  re- 
port, "even  on  the  most  sanguine  view  of  the  cases  one 
fails  to  find  any  justification  for  the  enthusiasm  with 
which  the  so-called  'cure'  was  proclaimed  by  Dr.  Saleeby 


S26     THE  CONQUEST  OF  CANCER 

in  the  lay  press."  I  wonder  what  the  writer  now  thinks 
of  that  word  "any"  in  this  extract.  On  April  13,  1907, 
the  Hospital  reviewed  a  number  of  volumes  of  the  New 
Library  of  Medicine,  of  which  I  am  the  editor.  Its  re- 
marks were  exceedingly  generous  to  myself,  showing  that 
no  animosity  against  me  was  present,  but  not  so  with  the 
pancreatic  treatment  of  cancer.  The  series  includes  a 
volume  written  by  a  well-known  surgeon  at  my  request 
— made  before  Dr.  Beard's  experiments  were  published 
—to  show  the  public  that  the  surgeon  could  sometimes 
cure  cancer  if  only  he  were  called  in  early  enough.  My 
hope  was  thus  to  accomplish  in  Britain  the  useful  work 
of  education  begun  in  Germany.  The  reviewer  says  that 
the  author  "shows  the  failure  of  the  many  so-called  cures 
■ — -Christian  science,  X-rays,  high  frequency  currents, 
cancroin,  violet  leaves,  molasses,  trypsin,"  etc.  Note  the 
conjunction  of  molasses  and  trypsin.  Now  it  need  hardly 
be  said  that  I  could  not  permit  any  assertion  of  the  failure 
of  trypsin  to  appear  in  a  book  under  my  editorship,  even 
had  the  author  made  such  an  assertion,  which  he  did  not. 
There  is  no  syllable  in  the  book  anywhere  which  offers 
a  shadow  of  excuse  for  this  misstatement,  by  which  it  was 
made  to  appear  that  I,  the  only  public  advocate  of  Dr. 
Beard,  had  abandoned  my  belief  in  his  method.  On  the 
contrary,  the  volume  contained  the  best  account  of  the 
trustees  and  the  Moray  Research  Fund  of  the  University 
merely  observed  that,  if  the  theory  were  accepted,  it  only 
confirmed  his  argument  as  to  the  local  origin  of  cancer. 

I  am  merely  selecting  a  few  specimens  from  the  host 
which  might  be  quoted,  it  being  necessary  to  place  the 
attitude  of  the  medical  press  on  record,  partly  in  order 
to  explain  the  reception  of  the  new  treatment  and  partly 
for  its  general  sociological  interest  and  its  relevance  to. 


THE  POWERS  THAT  BE  327 

the  age-long  struggle  between  authority  and  originality 
in  all  spheres  of  human  activity.  But  I  do  not  mean  to 
burden  my  pages  with  more  than  will  suffice  for  these 
necessary  purposes.  In  dealing  with  the  Lancet,  the 
most  celebrated  medical  paper  in  this  country,  I  shall 
content  myself  with  one  abundant  fact.  On  February  4, 
1905,  the  Lancet  published  a  paper  by  Dr.  Beard,  entitled 
'The  Cancer  Problem."  This  was  an  abstract  of  the 
paper  read  by  him  before  the  Edinburgh  Pathological 
Club  on  December  13,  1904,  a  date  which  may  be  remem- 
bered down  the  years,  and  containing  the  first  statement 
of  the  theory  that  the  pancreatic  ferment  trypsin  should 
afford  a  means  of  opposing  the  growth  of  cancer.  In 
1902  Dr.  Beard  had  declared  that  cancer  is  "irresponsible 
trophoblast,"  and  in  this  paper,  two  and  a  half  years  later, 
he  completed  his  work. 

The  Lancet  discussed  this  memorable  paper  in  its  lead- 
ing article,  from  which  I  make  the  following  extracts : — 

"We  publish  to-day  a  paper  on  cancer  by  Dr.  John 
Beard,  lecturer  on  comparative  embryology  in  the  Uni- 
versity of  Edinburgh,  which  is  the  third  of  a  series  that 
has  appeared  in  our  columns.  The  writer  states  that  it 
is  based  on  work  carried  out  with  the  support  of  the 
ample  funds^  for  research  at  the  disposal  of  the  Carnegie 
trustees  and  the  Moray  Research  Fund  of  the  University 
of  Edinburgh.  We  have  thought  it  well  to  find  space 
for  this  paper,  for  it  seems  to  us  to  be  a  serious  matter 
that  it  has  been  produced  with  the  countenance  of  the 
wealthiest  endowment  for  research  in  this  country.  The 
present  contribution  is  itself  the  best  commentary  and 
criticism  upon  the  two,  previous  articles,  and  its  character 

»A  few  shillings  of  these  "ample  funds"  were  all  that  Dr.  Beard 
expended. 


328     THE  CONQUEST  OF  CANCER 

makes  it  incumbent  upon  us  to  state  clearly  the  illogical 
reasoning  upon  which  Dr.  Beard's  conclusions  are  based, 
seeing  that  they  have  already  received  qualified  accept- 
ance from  some  pathologists  who  probably  would  not  sub- 
scribe to  a  bald  statement  of  the  fundamental  conceptions 
upon  which  a  fantastic  but  seemingly  logical  superstruc- 
ture has  been  raised.    .    .    . 

"In  short,  Dr.  Beard  passes  from  one  conjecture  to 
another.  He  begins  by  views  on  embryology  which  on 
his  own  showing  are  not  generally  accepted  by  embryolo- 
gists.  He  goes  on  to  express  opinions  on  the  histology 
and  the  pathology  of  cancer  which  are  not  in  accordance 
with  known  truths,  and  launches  into  the  realm  of  thera- 
peutics with  assertions  about  the  action  of  ferments  which 
would  inevitably  cause  the  rejection  of  a  candidate  in 
physiology.  We  are  anxious  to  encourage  the  serious 
biological  investigation  of  cancer,  and  we  trust  that  we 
are  doing  so  by  eliminating  from  the  hypotheses  worthy 
of  future  consideration  one  characterized  by  more  wild 
speculations  in  more  fields  of  knowledge  than  any  other 
with  which  we  are  acquainted.  In  the  present  chaotic 
state  of  the  cancer  problem  there  is  much  preliminary 
clearing  up  to  be  done,  and  we  can  only  regret  that  our 
opinions  on  the  nature  of  those  biological  investigations 
of  cancer  which  are  worthy  of  financial  support  differ 
so  essentially  from  those  entertained  apparently  by  the 
Carnegie  trustees  and  the  Moray  Research  Fund  of  the 
University  of  Edinburgh.  In  estimating  the  value  of 
contributions  such  as  that  which  we  publish  to-day,  much 
larger  issues  are  raised  than  the  mere  scientific  value  of 
the  paper  itself.  By  the  indiscriminate  distribution  of 
funds  for  research  purposes,  proper  support  may  be  di- 
verted from  more  important  research  in  the  true  sense 


THE  POWERS  THAT  BE  329 

of  the  word,  and  the  question  of  the  competence  and  the 
responsibihties  of  those  administering  funds  for  research 
purposes  may  obtain  a  prominence  unfavorable  to  the  rep- 
utation of  British  scientific  medicine." 

This  article  is  none  other  than  a  scurrilous  personal 
attack  on  Dr.  Beard.  The  Lancet  turned  to  its  lasting 
dishonor  an  occasion  which  would  otherwise  have  re- 
dounded to  its  lasting  honor.  It  printed  the  paper,  as 
the  writer  says,  only  in  order  to  discredit  it.  The  iden- 
tity of  the  writer  is,  of  course,  unknown.  He  is  pro- 
tected by  the  anonymity  which  has  been  the  disgraceful 
defense  of  nearly  every  one  who,  during  the  past  two 
years  or  so,  has  fought  against  the  new  treatment.  There 
is  internal  evidence,  and  other  evidence,  which  makes  it 
certain  that  the  writer  was  himself  a  cancer  researcher, 
and  highly  probable  that  he  was  the  most  prominent 
among  such  workers  in  Great  Britain  at  the  time.  Who- 
ever he  was,  he  may  here  be  dismissed  with  a  gesture  of 
disgust. 

We  must  now  proceed  to  the  case  of  the  British  Med- 
ical Journal,  to  which  special  sociological  importance  at- 
taches. This  is  the  official  journal  of  the  medical  pro- 
fession in  Great  Britain,  in  that  it  is  the  official  journal 
of  the  British  Medical  Association.  No  other  journal  in 
this  country  speaks  with  nearly  so  much  authority ;  none 
other  has  so  much  power.  It  has  an  enormous  circula- 
tion within  the  profession  and  a  very  large  circulation 
outside  it.  It  is  pre-eminently  the  type,  then,  of  an  estab- 
lished and  official  power,  and  its  attitude  in  this  matter 
may  well  be  studied  by  any  student  of  the  principles  of 
progress  as  a  test  case  in  determining  the  relation  of 
authoritative  and  established  institutions  towards  the 
pioneer.     We  shall  have  to  decide  whether  in  this  matter 


350     THE  CONQUEST  OF  CANCEK 

it  has  acted  as  the  Church  in  the  case  of  Savonarola,  the 
Royal  Academy  in  the  case  of  M.  Rodin,  the  University 
of  Oxford  in  the  case  of  Locke,  the  Italian  universities 
in  the  case  of  Galileo,  and,  in  short,  all  established  insti- 
tutions of  whatever  kind  in  all  times  and  places. 

Just  as  the  Lancet  was  honored  by  publishing  the  first 
statement  of  the  only  substantial  discovery  regarding 
cancer  that  has  ever  been  made,  so  was  the  British  Medi- 
cal Journal  honored,  as  we  have  seen,  by  publishing,  on 
January  20,  1906,  the  result  of  the  first  experiments  in 
confirmation  of  that  discovery.  This  was  printed  with- 
out comment,  though  it  is  evident  that  critical  comment 
based  upon  knowledge  would  have  been  invaluable  at 
such  a  juncture,  and  that  abundant  opportunity  for  such 
comment  was  afforded.  Shortly  afterward  the  journal 
published  a  "special  cancer  number"  which  took  no  note  of 
the  new  work,  while  the  corresponding  journal  in  America 
{Journal  of  the  American  Medical  Association),  which  is 
not  the  prophet's  own  country,  did  afford  a  certain  amount 
of  space  to  the  subject  after  the  publication  of  my  first 
article  in  Harpers  Weekly.  None  was  afforded  it  in  the 
British  Medical  Journal.  This  passive  resistance,  how- 
ever, assumed  an  active  form  on  the  publication  of  my 
article  in  the  Pall  Mall  Gazette  on  December  10,  1906,  in 
which,  having  received  from  Prof.  jNIorton  an  advance 
copy  of  his  report  of  December  8,  I  published  his  main 
conclusions.  On  December  15  the  British  Medical  Jour- 
nal published  an  article  censuring  me.  I  have  refrained 
from  any  reply  to  the  journal  until  this  present  because 
I  was  aware  of  the  fashion  in  which  Dr.  Beard's  letters 
were  treated  by  the  suppression  of  one  sentence  and  the 
insertion  of  another.  By  such  methods  it  is  possible  to 
make  your  opponent  assert  that  which  he  denies,  and 


THE  POWERS  THAT  BE  351 

conversely,  and  there  is  no  remedy.  Thus  my  present 
mode  of  reply  is  more  convenient.  The  article  I  refer 
to  should  really  be  read  in  full.  I  have  no  taste  for  noi- 
some dissection,  and  will  not  discuss  it  further.  In  the 
following  week  there  was  a  second  article  of  the  same 
quality  as  the  first. 

The  journal  publishes  every  week  an  epitome  of  im- 
portant communications  to  the  medical  press  abroad.  As 
month  followed  month  it  published  only  an  account  of 
Prof.  Morton's  report,  which  I  had  made  it  impossible 
to  ignore,  of  a  report  of  failure  by  an  incompetent  Ameri- 
can practitioner  whom  I  need  not  name,  and  of  Dr.  Rice's 
case.  The  attention  of  the  readers  of  its  epitome  was 
not  drawn  to  a  single  one  of  the  successful  results  which 
were  recorded  in  the  American  medical  press  from  Janu- 
ary, 1907,  onward,  though  the  journals  were  of  the  high- 
est repute,  and  though  week  by  week  the  epitome  included 
accounts  of  other  communications  to  those  same  journals. 
The  work  of  the  British  Medical  Journal,  however,  con- 
sisted in  the  publication  of  a  highly  adverse  article  on 
January  19;  yet  another  (January  26),  on  an  address 
delivered  by  the  general  superintendent  of  the  Imperial 
Cancer  Research  Fund,  and  then  on  March  2  a  trium- 
phant article,  accompanying  a  critical  paper  in  which  a 
single  one  of  Dr.  Morton's  twenty-nine  cases  was  further 
discussed.  This  case  did  not  maintain  its  improvement, 
and  the  growth  recurred  after  the  operation.  This  active 
recurrence  after  operation  was  taken  as  evidence  against 
trypsin,  whereas,  of  course,  it  was  really  evidence  against 
the  knife.  Elsewhere  I  discuss  Von  Leyden's  principle 
of  the  reaction  of  malignant  tissue  to  mechanical  injury. 

From  December,  onward,  I  waited  impatiently  for  sev- 
eral months  before  returning  to  the  attack,  meanwhile 


332  THE  COXQL-EST  OF  CANXER 

having  my  belief  in  Dr.  Beard  cormnTied  by  the  cases  I 
was  mjself  observing,  in  company  \N-ith  ray  friend.  Dr. 
Meggitt,  who  was  responsible  for  them.  These  patients 
owed  the  incalculable  benefits  they  received  not  to  the 
medical  press,  but  to  the  Pall  Mall  Gazette.  There  then 
appeared  Prof.  Xon  Leyden's  confirmation  of  Dr.  Beards 
main  thesis,  that  tripsin  has  a  specific,  digestive  and 
toxic  action  upon  hving  malignant  cells.  Armed  wnth 
this  and  other  evidence,  I  wrote  a  further  article  in  the 
Daily  Chronicle  (May  i8,  1907),  described  as  "by  a  stu- 
dent," and  a  series  of  eight  articles  in  the  Daily  Mail, 
b^^inning  ]May  29,  described  as  ''from  a  special  corre- 
spondenL"  To  these  the  British  Medical  Journal  repUed 
in  an  article  of  June  15,  entitled  "Another  Cancer  Boom." 
The  writer  asks,  "But  how  on  earth  is  the  medical  pro- 
fession to  study  seriously  cases  that  are  not  reported," 
and  declared  that  the  British  Medical  Journal  "has  im- 
partiall}-  published  reports  of  all  the  cases  that  have  come 
within  its  ken.  We  have  further  carefully  analyzed  the 
clinical  evidence  appealed  to  b}-  the  supporters  of  the 
new  method.  We  have  not,  however,  been  so  fortunate 
as  to  find  a  single  case  of  cure,  even  in  the  limited  sense 
in  which  that  word  is  used  b}-  surgeons."  In  this  article 
the  name  of  Prof.  Von  Leyden  and  his  work  were  not 
mentioned.  This  is  to  say  that,  even  in  the  face  of  the 
Daily  Mail  articles,  the  journal  took  upon  itself  the  re- 
sponsibihty  of  continuing  to  suppress,  in  so  far  as  was 
possible,  the  authoritative  German  confirmation  b}^  the 
chief  Hving  authority  on  cancer  in  the  whole  world,  and 
to  deny  the  existence  of,  for  instance,  the  two  cases  re- 
ported cured  hy  Prof.  Morton  in  December,  though  these 
had  been  epitomized  in  its  own  columns,  not  to  mention 
jmaxy  other  cases,  some  of  which  are  elsewhere  referred 


THE  POWERS  THAT  BE  333 

to.  The  writer  then  proceeds  to  say  that  the  writer  of 
the  Daily  Mail  articles  ■'cites  as  examples  of  cure  cases 
that  have  been  publicly  shown  to  be  nothing  of  the  kind.'' 
This  is  an  absolutely  inexcusable  rendering  of  the  fact 
that  one  of  Prof.  I\Iorton's  twenty-nine  cases  had  been 
criticized  successfully,  as  Iiadmit.  Xo  other  case,  either  of 
Prof.  ^lorton  or  any  one  else,  had  been  publicly  criticized 
anywhere;  nor  had  I  cited  this  as  an  example  of  cure. 
The  writer  then  goes  on  to  say  that  "Prof.  ^Morton's  cases 
are  again  trotted  out.  and  it  is  said  that  he  had  already 
obtained  "two  absolute  cures'  when  he  wrote,  'while  in 
every  case,  without  exception,  the  patient  was  benefited.' 
This  is  simply  untrue."  I  have  no  words  for  this  inde- 
scribable statement,  which  simply  consists  in  giving  the 
lie  to  Prof.  ^Morton,  who  did  actually  in  his  report  of 
December  8  state  that  two  cases  had  been  cured,  and 
that  "in  all  cases  signs  of  amelioration  in  the  progress  of 
the  disease  have  been  observed." 

Then  the  British  Medical  Journal  proceeded  to  excel 
itself.  It  said:  "Prof.  Morton  has  since  pubHshed  a 
series  of  cases  of  cancer  treated  by  another  method,  and 
this  at  least  suggests  that  his  faith  in  the  pancreatic  treat- 
ment is  perhaps  a  little  shaken."  I  wrote  at  once  to  Prof. 
iMorton  and  ascertained  the  facts,  which  I  here  put  on 
permanent  record :  In  the  first  place,  he  had  published  in 
the  Xezi'  York  Medical  Journal,  I\Iarch  9,  1907,  a  new 
case  in  which  the  treatment  had  been  absolutely  success- 
ful. This  case  was  not  reported  by  the  British  Medical 
Journal  in  its  epitome.  As  for  the  "series  of  cases  treated 
by  another  method,"  the  fact  is  that  this  was  merely  a 
paper  on  the  X-ray  treatment  of  cancer,  which  had  been 
originally  read  by  Prof.  ]\Iorton  in  ]\Iay,  igo6,  a  few  days 
after  his  attention  had  first  been  directed  to  trypsin.    In 


334     THE  CONQUEST  OF  CANCER 

his  letter  (June  31)  to  me  Prof.  Morton  describes  the 
statement  of  the  British  Medical  Journal  in  terms  too 
contemptuous  for  me  to  reproduce.  In  that  letter  he 
also  says,  "I  have  published  no  cases  of  cancer  treated 
by  any  other  method  since  my  trypsin  series  of  cases,  nor 
is  my  faith  in  the  pancreatic  treatment  in  the  least  shaken 
— on  the  contrary,  it  has  steadily  grown." 

The  article  concludes  by  saying:  "With  Dr.  Beard's 
theory  we  are  not  here  concerned ;  it  is  the  practical 
result  that  interests  us.  What  that  has  been  so  far  we 
leave  our  readers  to  judge."  We  have  observed  in  what 
manner  the  journal  attempted  to  assist  the  judgment  of 
its  readers.  The  next  statement  is  that  it  is  foolish  to 
suggest  that  the  new  treatment  may  be  a  serious  matter 
financially  to  the  surgeons,  since  "the  profession  can  only 
gain  by  any  increase  of  its  resources  against  disease." 
Now  I  will  not  go  so  far  as  to  say,  as  has  been  said,  that 
the  surgeon's  prayer  is,  "Give  me  this  day  my  daily  tu- 
mor" ;  but  if  any  one  will  maintain  that,  let  us  say,  the 
elimination  of  cancer  from  the  sphere  of  surgery  would 
be  a  matter  of  financial  gain  to  surgeons,  I  am  content 
to  leave  him  to  the  refutation  of  universal  laughter.  The 
last  sentence  of  this  article,  referring  to  a  genuine  cure 
for  cancer,  says,  "Unhappily,  we  see  no  sign  that  it  has 
3'et  come."  Perhaps  the  one  form  of  blindness  which  no 
science  will  ever  cure  is  that  of  those  who  will  not  see. 
The  omission  of  any  reference  to  Von  Leyden's  work  was 
a  piece  of  daring  which  astonished  me,  but  we  were  to 
find  in  a  short  time  that,  though  his  work  was  not  men- 
tioned, the  Daily  Mail  references  were  attended  to. 

In  my  judgTnent,  the  article  I  have  cursorily  analyzed 
touches  the  nadir  of  controversy.     I  am  happy  to  say 


THE  POWERS  THAT  BE  335 

that  it  was  the  last  but  one  of  its  kind.  The  tide  had  to 
turn  at  last. 

In  the  next  four  issues  of  the  British  Medical  Journal 
there  was  abundant  opportunity  for  yet  more  blows  at 
trypsin.  For  instance,  the  journal  published  (July  6, 
1907)  the  highly  important  report  of  the  Imperial  Cancer 
Research  Fund  Committee,  which  condemned  trypsin  as 
without  action  on  cancer.  This  conclusion  was  put  into 
the  mouth  of  H.  R.  H.  the  Prince  of  Wales,  and  was 
quoted  and  commented  upon  everywhere.  To  my  absolute 
astonishment,  the  journal  published  the  report,  not  merely 
without  a  leading  article  on  the  subject,  but  without  even 
an  editorial  paragraph.  I  say  absolute  astonishment, 
because  in  the  face  of  the  fact  that  Prof.  Von  Leyden's 
confirmation  of  Dr.  Beard  had  been  ignored  for  months, 
I  had  begun  to  persuade  myself,  I  suppose,  that  the  Brit- 
ish Medical  Journal  would  brazen  out  its  opposition  to 
trypsin  to  the  end  of  time.  In  the  following  week  the 
journal  might  have  been  expected  to  reply  to  Dr.  Beard's 
fierce  indictment,  printed  under  his  name,  in  the  Observer 
of  July  7.  No  allusion  was  made  to  this,  however.  The 
case  was  explained  in  the  succeeding  issue — that  of  July 
20.  Here,  also,  there  was  no  reference  to  the  Observer 
discussion,  which  was  still  continuing. 

But  there  was  something  else,  and  if  any  one  is  unac- 
quainted with  the  meaning  of  the  word  disingenuous,  I 
submit  to  his  notice  the  leading  article  of  July  20,  1907, 
entitled  'The  Pathogenesis  of  Malignant  Tumors."  The 
writer  discussed,  for  the  first  time,  the  work  of  Von 
Leyden  with  the  liver-ferment,  and  admitted  Von  Ley- 
den's demonstration  of  the  specific  action  of  trypsin  on 
cancer — indirectly,  in  a  fashion  I  will  show.  No  refer- 
ence was  given  to  the  most  important  paper  in  the  Zeit- 


336  THE  CONQUEST  OF  CANX^EK 

schrift  filr  kUnische  Medizin,  and  no  allusion  to  that  paper 
has  yet  been  made  in  the  journal,  though  it  has,  of  course, 
been  epitomized  in  the  Journal  of  the  American  Medical 
Association,  and  was  prominently  noticed  in  France. 

The  nature  of  this  paper  was  commented  upon — not 
by  me — in  the  Daily  Chronicle,  drawing  a  reply  from  the 
journal  (July  27,  1907).  This  reply,  besides  much  irrele- 
vant humor  of  sorts,  and  a  complete  avoidance  of  the 
question  at  issue,  contains  this  remark  of  the  treatment: 
''What  we  ask  for  are  some  authentic  facts  in  proof  of 
its  practical  value."  I  will  show  that  the  facts  recorded 
abroad  had  been  systematically  suppressed  by  the  journal ; 
and  even  when  Dr.  Beard,  in  writing  to  it,  gave  the  ref- 
erence to  a  noteworthy  report,  published  in  the  Journal  of 
the  American  Medical  Association,  the  paragraph  con- 
taining the  reference  was  omitted  from  Dr.  Beard's  letter 
as  printed. 

I  had  already  asked  the  editor  of  the  Observer  to  send 
an  interviewer  to  me,  and  my  remarks  appeared  in  that 
paper  on  July  14.  I  did  not  give  my  name — following 
the  policy  pursued  in  the  Daily  Mail,  the  Daily  Chronicle, 
and  the  Morning  Post,  since,  constituting  an  army  of 
one,  I  had  to  adopt  the  obvious  stage  device,  and  since 
I  did  not  want  to  make  possible  the  argument  that  this 
was  only  Dr.  Saleeby  again.  But  on  the  publication  of 
the  latest  article  in  the  British  Medical  Journal  I  sent  a 
signed  letter  to  the  Observer,  the  greater  part  of  which 
was  printed  on  July  28,  1907,  under  the  headings,  "Burk- 
ing the  Trypsin  Treatment :  Why  English  Research  Has 
Failed."  The  headings  for  the  interview  were,  "Strong 
Indictment:  Why  England  Lags  Behind."  I  here  print 
my  letter  as  it  appeared.  I  followed  it  the  next  week  by 
a  brief  note  of  some  recent  references. 


THE  POWERS  THAT  BE  337 

"Your  readers  and  the  public  are  much  indebted  to 
you  for  taking  up  the  question  of  Dr.  Beard's  work  on 
cancer.  The  recent  report  of  the  Imperial  Cancer  Re- 
search Fund  Committee,  condemning  trypsin  as  without 
action  on  cancer — an  opinion  which  was  put  into  the 
mouth  of  H.  R.  H.  the  Prince  of  Wales,  and  has  been 
quoted  everywhere — contains  no  statement  of  the  evi- 
dence for  this  opinion,  which  is  merely  of  the  'because  I 
say  so'  order,  and  has  no  relation  to  what  is  known  as 
science.  As  your  readers  are  aware,  the  committee  was 
long  ago  challenged  by  Dr.  Beard  to  state  the  details  of 
their  experimental  methods,  and  that  challenge  was  de- 
clined. The  time  is  not  ripe  for  a  scientific  report,  we 
are  told;  but  the  time  was  not  thought  unripe  for  the 
broadcast  assertion,  without  evidence,  of  a  statement 
which  is  now  merely  ridiculous. 

"It  may  be  remembered  that  I  recently  discussed,  at 
length,  the  work  of  Prof.  Von  Leyden,  noting  his  def- 
inite and  mature  conclusion  that  trypsin  has  a  specific 
toxic  action  upon  malignant  tissues.  In  criticizing  those 
articles  and  the  remarks  of  the  Ohsen>er,  the  British 
Medical  Journal  made  no  allusion  to  Von  Leyden  nor  his 
work,  which  had  been  entirely  ignored  in  its  columns. 
But  it  became  evident  to  me  that  the  tide  was  about  to 
turn,  when,  to  my  astonishment,  I  found  that  the  British 
Medical  Journal,  publishing  the  report  of  the  I.  C.  R.  F. 
committee,  made  no  editorial  comment  thereon.  This 
was  of  some  interest,  since  the  journal  has  hitherto 
missed  no  opportunity  of  writing  in  opposition  to  trypsin. 

"A  writer  in  that  journal  made  attempts  to  weaken  the 
case  for  trypsin  by  saying  that  Prof.  Morton,  the  first 
American  physician  to  act  on  Dr.  Beard's  teaching,  has 
published,  since  his  favorable  report  of  last  December,  a 
report  of  cases  of  cancer  f-eated  by  another  method,  'and 
this  at  least  suggests  that  his  faith  in  the  pancreatic  treat- 
ment is  perhaps  a  little  shaken.'  I  have  an  indignant  let- 
ter from  Prof.  Morton  commenting  on  this.  I  will  not 
quote  his  contemptuous  characterization  of  it,  but  will 
merely  observe  that  our  anonymous  writer  omitted  to 


338     THE  CONQUEST  OF  CANCER 

note  that  the  paper  in  question  is  merely  a  paper  on  the 
X-ray  treatment  of  cancer  which  was  read  by  Professor 
Morton,  in  May,  1906,  a  few  days  after  his  attention  had 
first  been  directed  to  trypsin,  I  submit  that  the  appro- 
priate comments  on  a  style  of  controversy  which  descends 
to  such  methods  will  spontaneously  occur  to  the  reader, 
and  I  may  pass  on.  Alerely  I  will  note  that  Prof.  Mor- 
ton has  published,  since  his  first  report,  a  further  success- 
ful case — which  has  been  absolutely  ignored  by  the  Brit- 
ish Medical  Journal,  and  that,  in  his  letter  to  me  (June 
31),  he  says :  *I  have  published  no  cases  of  cancer  treat- 
ment by  any  other  method  since  my  trypsin  series  of 
cases,  nor  is  my  faith  in  the  pancreatic  treatment  in  the 
least  shaken ;  on  the  contrary,  it  has  steadily  grown.' 

"But  there  is  something  else.  It  is  a  leading  article, 
entitled  'The  Pathogenesis  of  Cancer,'  and  in  it  the  read- 
ers of  the  journal  are  introduced  in  a  curiously  imperfect 
fashion  to  the  work  of  Von  Leyden.  The  greatest  part 
of  the  article  is  devoted  to  Von  Ley  den's  newest  work 
on  the  use  of  a  liver-ferment  in  cancer.  There  is  no  men- 
tion of  Dr.  Beard,  no  word  of  trypsin.  This  ferment  is 
judiciously  referred  to  as  'pancreatin,'  or,  most  amus- 
ingly, as  'the  pancreatic  ferment.'  There  are  at  least 
four  pancreatic  ferments,  but  the  simple  word  trypsin 
was  taboo,  like  Dr.  Beard's  name.  However,  the  specific 
digestive  action  of  'pancreatin'  upon  malignant  tissue  is 
acknowledged  for  the  first  time  in  any  leading  medical 
journal  in  this  country. 

"I  suggest  that  the  puerile  and  inaccurate  subtlety  of 
calling  trypsin  the  'pancreatic  ferment'  be  discarded,  and 
that  the  readers  of  the  official  journal  of  the  medical  pro- 
fession be  informed  frankly,  and  not  in  the  fashion  of  the 
article  I  refer  to,  that,  in  spite  of  the  ignorant  abuse  to 
which  Dr.  Beard  and  myself  have  been  subjected  in  its 
pages  on  every  possible  occasion,  Dr.  Beard's  magnificent 
theory  of  the  specific  destructive  action  of  (active) 
trypsin  on  malignant  tissue  (first  stated  on  December  13, 
1904)  has  been  conclusively  confirmed  by  the  world- 
famous  experts  of  the  Cancer  Research  Institute  of  Ber- 


THE  POWERS  THAT  BE  339 

lin,  and  that  from  America  and  Italy  and  Germany  have 
already  come  a  number  of  detailed,  responsible  and  inde- 
pendent reports  which  demonstrate  the  magnificently  suc- 
cessful application  of  this  fact  to  the  rescue  of  victims 
of  cancer. 

"If  patients  can  be  saved  in  America — and  now  not  in 
America  only — why  not  here  also?  In  point  of  fact,  a 
few  patients  are  being  saved  here,  patients  whom  surgery 
has  abandoned  and  Avho  have  no  hope  but  this  in  the 
world.  I  myself,  though  I  do  not  practice  medicine  for 
fees,  am  watching,  and  have  long  been  watching,  such 
cases  in  consultation  with  the  physician  in  charge.  Noth- 
ing has  been  published,  because  it  seemed  useless  to  seek 
publication  in  the  face  of  the  attitude  of  the  medical 
press  and  the  Imperial  Cancer  Research  Fund ;  but  the 
tide  has  now  turned,  and  Ave  shall  publish  soon.  Mean- 
while many  patients,  abandoned  by  the  surgeons  who  can 
do  no  more  for  them,  and  almost  persuaded  to  undergo 
the  treatment  (which  involves  no  risk)  by  my  various 
publications  in  the  lay  press,  have,  as  I  know,  been  dis- 
suaded by  the  opinion — I  will  not  abuse  language  by 
calling  it  a  verdict — of  the  I.  C.  R.  F.  Committee,  which 
must  now  be  arousing  curious  reflections  in  New  York 
and  Berlin." 

To  this  letter,  involving  the  most  serious  suggestions 
as  to  the  honor  of  the  official  journal  of  the  medical  pro- 
fession, charges  made  under  the  signature  of  a  member 
of  the  British  Medical  Association,  no  reply  whatever 
was  made.  This  public  and  detailed  and  signed  incrim- 
ination of  the  journal,  accusing  it  of  misrepresentation, 
of  suppressing  vital  facts,  and  of  ignorant  abuse  in  place 
of  argument,  remains  unanswered  to  this  day,  as  does  the 
interview  with  me,  and  Dr.  Beard's  Observer  article  and 
my  Contemporary  Review  article.  I  suggest  that  no  re- 
ply was  made  to  accusations  so  dishonoring  to  the  ac- 
cused, if  true,  and  to  the  accuser,  if  untrue,  because  there 
was  no  reply  to  make. 


S40     THE  CONQUEST  OF  CANCER 

This  discussion  cannot  disgust  the  reader  more  than  it 
does  me,  and  I  have  nearly  done.  Merely  I  note,  how- 
ever, that  the  journal  has  repeatedly  asked  for  facts,  and 
has  declared  that  it  has  always  noticed  facts  brought  to 
its  attention.  It  weekly  publishes  an  epitome  of  the  prin- 
cipal articles  in  the  medical  press  elsewhere.  During  the 
present  year  it  has  published  an  epitome  of  one  report 
on  trypsin,  found  in  a  minor  American  organ,  the  Boston 
Medical  and  Surgical  Journal.  The  reporter  was  obviously 
incompetent ;  his  report  was  adverse ;  it  was  epitomized 
at  great  length.  But  no  epitomes  have  appeared  of  the 
following  reports,  published  during  1907,  and  I  have 
already  noted  the  deliberate  suppression  of  the  paragraph 
in  a  letter  of  Dr.  Beard's  which  drew  attention  to  one  of 
them  : 

JV.  Y.  Medical  Record,  Jan.  5,  Feb.  2,  June  i,  July  6. 

Journal  A.  M.  A.,  Jan.  19. 

N.  Y.  Medical  Jozirnal,  Feb.  23,  March  9. 

New  Orleans  Medical  and  Surgical  Journal,  July. 

]\leanwhile  neighboring  articles  from  these  same  jour- 
nals, the  first  three  of  which  are  the  three  leading  medical 
publications  in  America,  were  epitomized.  I  state  the 
fact  and  submit  it  for  interpretation  by  the  public  and  the 
grievously  misled  general  practitioner.  Lastly,  I  turn  to 
Germany,  and  note  the  following  papers,  of  which  no 
notice  whatever  has  been  taken.  In  each  of  them  the 
specific  action  of  trypsin  upon  cancer  is  asserted : 

E.  Von  Leyden:  Zeitschrift  fiir  klinische  Medizin,  Vol.  61,  pp. 
360-365. 

F.  Blumenthal:  Ezgebnisse  der  Exper.  Pathol.  U7id  Therap.,  Vol. 
1,  Pt.  I,  1907,  pp.  65-104. 

Neuberg  and  Ascher:  Arbeiten  a.  d.  Pathol.  Institut  zu  Berlin, 
1906. 

P.  Bergell :  Zeitschrijt  fiir  Krebsforschung,  Vol.  5,  pp.  204-208. 

Pinkuss  and  Pinkus:  Medizin.  Klinik,  Nos.  28  and  29,  1907. 


THE  POWERS  THAT  BE  341 

This  is  the  fact  of  the  behavior  of  the  journal  which 
almost  weekly  denied  the  existence  of  facts  in  this  matter 
and  desired  to  be  informed  of  them. 

It  is  a  natural  consequence  of  the  action  of  this  journal 
that  neither  at  the  British  Medical  Association  Annual 
Meeting  at  Toronto  in  1906,  nor  in  Exeter  in  1907,  was 
any  paper  for  or  against  the  pancreatic  or  any  other 
ferment  treatment  of  cancer  read  or  referred  to. 

It  may  be  noted  that  the  principal  American  journals 
can  always  be  consulted  in  the  reading  room  of  the 
British  Medical  Association,  and  that  a  visitor,  having 
read  the  demand  for  facts  and  cases  to  be  studied,  had 
only  to  stretch  out  a  random  hand  without  even  leaving 
his  seat  to  pick  up  in  its  own  home  the  records  of  which 
the  journal  before  him  denied  the  existence.  It  is  im- 
possible to  believe  that  any  writer  could  pen  a  demand 
for  records  and  deny  their  existence  with  his  right  hand, 
and  drop  them  into  the  waste-paper  basket  or  put  them 
under  cover  with  his  left.  This  increases  the  probability 
that  the  writer  in  question  sends  in  his  contributions  to 
the  office  from  the  outside.  I  do  not  know  how  it  should 
come  about  that,  being  entrusted  with  the  discussion  of 
this  subject  for  the  most  responsible  medical  journal  in 
this  country,  he  should  be  entirely  unacquainted  with  its 
current  literature,  whether  American  or  German.  Still 
less  do  I  understand  why,  failing  to  make  himself 
acquainted  with  it,  he  should  deny  its  existence.  If  tryp- 
sin were  proved  to-morrow  to  be  a  constant  and  deadly 
poison,  it  would  still  be  impossible  for  the  British  Medical 
Journal  to  defend  itself  should  it  make  a  tardy  attempt 
to  do  so.  I  find  it  impossible  to  believe  the  less  charita- 
ble hypothesis,  and  so  I  must  leave  this  point  merely  with 
a  note  of  astonishment  at  the  existence  of  such  a  person 


342     THE  CONQUEST  OF  CANCER 

as  this  unknoA^■n  writer,  not  to  mention  his  employment 
in  any  responsible  quarter.  I  may  note  in  passing  that 
I  am  greatly  indebted  to  the  invaluable  opportunities 
afforded  by  the  reading  room  of  the  British  Medical  As- 
sociation for  the  collection  of  favorable  reports  on  the 
ferment  treatment  of  cancer.  It  has  been  highly  con- 
venient to  visit  that  comfortable  room,  gather  up  the 
evidence,  and  write  my  comments  on  the  journal  there. 

Lastly,  Dr.  Francis  Cavanagh,  whose  remarkable  re- 
port I  refer  to  elsewhere,  has  forwarded  me  some  facts 
and  documents  with  his  permission  to  employ  them  as  I 
think  fit.  He  sent  his  report  to  the  British  Medical  Jour- 
nal on  August  7,  1907.  Three  weeks  later,  August  28, 
he  wrote  commenting  on  the  omission  of  any  acknowledg- 
ment, either  by  post  or  in  the  journal,  and  stating  that  he 
intended  to  publish  elsewhere.  Thereupon  his  report  and 
letter  were  acknowledged  in  a  letter  from  the  editor  of 
the  journal,  who  states  that  the  cases  are  too  incomplete 
for  publication,  that  they  are  inconclusive,  and  that  "in 
regard  to  the  first  case  in  particular  there  is  no  proof  that- 
the  tumor  was  of  a  malignant  nature."  The  curious 
reader  will  refer  to  Dr.  Cavanagh's  report  for  himself  as 
to  this. 

My  friend  Dr.  Cavanagh  being  a  contributor  to  the 
General  Practitioner,  I  was  enabled  to  draw  his  attention 
to  this  matter,  and  in  consequence  that  paper  is  the  only 
medical  publication  of  any  note  in  this  countn,^  that  has 
not  opposed  the  new  treatment.  I  discuss  its  services  in 
another  chapter,  and  here  note  that  the  British  Medical 
Journal  has  made  no  reply  to  its  recent  editorial  article 
of  September  7.  Apart  from  this  guidance  the  general 
practitioner,  who  has  no  time  to  read  the  foreign  and 
American  medical  press,  has  throughout  been  completely 


THE  POWERS  THAT  BE  343 

kept  in  the  dark  as  to  the  results  obtained  and  the  work 
done  in  America  and  Germany,  while  of  the  few  prac- 
titioners who  have  communicated  with  Dr.  Beard  or  my- 
self, many  have  not  dared  to  seek  publication  of  their 
results.  Nothing  could  well  be  more  remarkable — or, 
to  the  student  of  progress,  less  remarkable — than  the  con- 
trast between  the  medical  press  in  this  country  and  that 
of  America  and  Germany  and  France  in  this  respect  dur- 
ing the  past  two  years.  Let  any  one  contrast  and  com- 
pare the  files  of  the  journals  of  the  British  Medical  Asso- 
ciation and  the  American  Medical  Association,  respect- 
ively, and  he  will  see  the  difiference  in  the  manner  in 
which  the  two  journals  have  influenced  their  readers. 
The  American  paper  has  not  declared  itself  a  believer  in 
trypsin,  but  it  has  not  published  editorial  articles  against 
it,  and  has  not  suppressed  all  allusion  to  the  (favorable) 
work  done  in  America  and  Germany. 

The  reader  will  observe  the  behavior  of  the  journal 
of  the  general  practitioner,  as  against  that  of  the  journal 
which  is  in  the  hands  of  the  specialists. 

I  pass  now  to  another  established  institution  which 
has  exercised  a  most  baneful  influence  upon  progress, 
both  in  its  own  name  and  through  the  medical  press  and 
the  surgeons.  It  was  not  the  intention  of  those — much- 
to-be-honored  surgeons  and  others — who  founded  and 
endowed  the  Imperial  Cancer  Research  Fund  to  stifle 
cancer  research.  But  he  who  founds  a  church,  or  an 
academy  of  painting  or  music,  or  any  other  institution, 
is  in  danger  of  injuring  the  very  cause  for  which  he 
works.  An  institution  may  perchance  find  a  man,  and 
he  will  possibly  work  as  well  within  it  as  he  would  with- 
out, though  even  he  runs  great  risks.  Failing  a  man, 
however,  posts  must  be  filled,  and  mummies  or  mounte- 


844  ,THE  CONQUEST  OF  CANCER 

banks  or  mammon-worshippers  may  be  installed,  and 
then  the  church  kills  religion,  the  academy  art,  the  re- 
search institute  science.  All  history  is  open  to  the  in- 
spection of  those  who  desire  to  see  these  principles  illus- 
trated. 

Long  ago  the  I.  C.  R.  F.  Committee  declined  to  supply 
Dr.  Beard  with  mice  for  his  experiments.  This  and  the 
host  of  similar  facts  in  this  chapter  mean  what  they  mean, 
whether  or  not  trypsin  is  remedial  in  cancer.  In  the 
Journal  of  the  American  Medical  Association  stands  the 
uncontradicted  statement  by  an  American  physician  that, 
during  the  Toronto  meeting  of  the  B.  M.  A.  in  1906,  Dr. 
Bashford,  the  director  of  the  I.  C.  R.  F.,  informed  him,  of 
trypsin,  that  "the  Imperial  Cancer  Research  Committee 
had  given  it  a  very  thorough  trial  and  had  no  good 
results  to  report  from  it."  I  have  reason  to  believe  that 
this  "thorough  trial"  consisted  of  injections  into  one 
mouse,  with  a  tumor  nearly  as  large  as  itself,  of  a 
trypsin-preparation  which  is,  or  has  been  until  lately, 
notoriously  inert.  Xo  details  whatever  as  to  these  expe- 
riments have  ever  been  published,  despite  the  repeated 
public  challenges  of  Dr.  Beard  and  myself,  and  I  am  will- 
ing to  predict  that  they  never  will  be. 

I  have  already  informed  the  reader  as  to  the  statement 
made  in  the  report  of  the  Committee  for  1907.  It  can- 
not be  criticised,  in  a  sense,  because  no  details  as  to  the 
experiments  are  published,  but  that  fact,  of  course,  con- 
stitutes in  itself  a  criticism  which  renders  the  report 
wholly  irrelevant  to  any  scientific  inquiry. 

It  w^ould  be  easy  to  show  that  during  the  five  years  of 
its  existence  the  Committee  has  not  hitherto  distinguished 
itself.  It  has  collected  some  statistics,  published  con- 
firmations of  other  people's  work,  and  then  withdrawn 


THE  POWERS  THAT  BE  345 

them,  and  has  figured  very  largely  in  the  public  eye. 
The  Committee  is  not  to  be  blamed  for  having  made  no 
substantial  addition  of  any  kind  to  our  knowledge  of 
cancer:  doubtless  it  did  its  best.  But  the  public  is  en- 
titled to  ask  why  the  published  challenge  of  Dr.  Beard, 
demanding  the  actual  facts  of  the  Committee's  experi- 
ments, has  been  wholly  ignored.  Meanwhile  the  failure 
of  these  undescribed  experiments  was  bruited  everywhere 
in  this  country,  and  by  a  critic  or  two  in  America,  as  an 
authoritative  verdict,  while  the  public  and  the  profession 
were  and  are  kept  wholly  in  ignorance  of  the  fact  that 
directly  opposite  conclusions  have  been  published  abroad 
by  some  of  the  greatest  living  experts,  with  full  details 
of  their  methods  and  procedure,  such  as,  of  course,  are 
inseparable  from  any  serious  scientific  report.  A  mere 
ex  cathedra  statement  may  be  repeated  in  good  faith  by 
the  Prince  of  Wales  and  scores  of  newspapers  ;  and  it  has 
the  advantage  of  avoiding  the  criticisms  which,  if  the 
details  were  made  known,  might  show  how,  in  one  or  in 
half  a  dozen  respects,  success  was  made  impossible.  I 
remind  the  reader,  in  passing,  of  a  fact  duly  made  known 
to  the  profession  in  America  but  ignored  in  Great  Brit- 
ain, that  Dr.  Beard's  results  in  the  mouse  have  long  ago 
been  confirmed  in  Italy  by  Dr.  Zanoni. 

It  may  be  noted  that  abundant  internal  evidence  sug- 
gests that,  as  is  natural,  the  directors  of  the  British  Med- 
ical Journal  have  intrusted  to  some  prominent  cancer 
researchers  the  discussion  of  cancer  in  its  columns.  To 
the  I.e.  R.  F.  Committee,  also,  may  probably  be  attributed 
the  answer  of  Sir  H.  Campbell-Bannerman,  in  the  House 
of  Commons  (June  2y.  1907),  to  the  question  whether 
he  would  appoint  a  Royal  Commission  upon  cancer. 
iThe  Premier  said  that  the  best  qualified  authorities  ad- 


U6  THE  CONQUEST  OF  CANCER 

vised  him  that  much  remained  to  be  done  before  such  a 
Commission  could  be  made  of  use. 

This  demand  for  a  Royal  Commission  to  inquire  into 
the  subject  had  already  been  made  by  me  in  the  Daily 
Mail,  and  I  here  repeat  it.  I  am  happy  also  to  draw 
attention  to  a  long  letter  published  in  the  Morning  Post, 
April  1 6,  1907,  and  signed  "F.  R.  C.  S."  The  writer  is 
unknown  to  me.  He  strongly  demands  the  appointment 
of  a  Royal  Commission,  and  says  of  the  use  of  trypsin 
in  cancer,  "the  uniformity  of  beneficial  results  has  been 
remarkable,"  and  "after  some  two  and  a  half  years  of 
the  practice  of  this  method,  it  may  with  truth  be  said 
that  a  milestone  in  the  roadway  of  the  history  of  this 
distressing  malady  has  been  reached."  I  only  wish  the 
writer  had  the  courage  to  publish  a  paper  on  the  results 
he  has  observed. 

As  evidence  of  the  results  which  followed  the  publica- 
tion of  the  I.  C.  R.  F.  Committee's  report,  it  will  suffice  to 
say  that,  having  sent  a  most  moderate  article,  containing 
all  the  available  evidence,  to  my  friend  the  editor  of  a 
leading  review,  I  received  a  letter,  dated  August  6,  1907, 
saying  that  he  could  not  print  it,  "in  view  of  recent 
authoritative  medical  opinion."  At  that  date  the  most 
authoritative  medical  opinion  in  the  world  had  already 
confirmed  the  specific  action  of  trypsin  on  cancer,  but 
the  opinion  of  the  I.  C.  R.  F.  Committee  and  the  Middle- 
sex Hospital  was  alone  known  in  this  country. 

It  is  an  amazing  index  of  the  power  of  authority  over 
the  human  mind,  or,  at  any  rate,  the  British  mind,  and 
of  the  totally  unscientific  attitude  of  public  opinion,  that 
it  should  be  possible  for  an  official  body  to  publish,  two 
years  in  succession,  a  condemnation  of  a  remedy,  with- 
out having  any  voice  in  the  whole  country  except  Dr. 


THE  POWERS  THAT  BE  547 

Beard's  aiid  mine  raised  to  ask  for  the  evidence  and 
further,  that  when  the  demand  is  made  in  the  leading 
scientific  journal,  it  should  be  possible  simply  to  ignore 
it  without  a  single  person  asking  why,  or  even  drawing 
attention  to  the  fact.  In  order  to  recognize  what  the 
power  of  names  and  positions  is,  let  us  suppose  that  the 
Committee  had  announced  a  discovery,  and  that  Dr. 
Beard,  of  whom  the  Director  of  the  Research  and  his 
second  in  command  are  pupils,  had  published  a  denial  of 
it,  without  a  word  as  to  the  grounds  for  his  opinion. 
No  one  would  have  paid  the  slightest  attention  to  him, 
and  rightly  so.  The  distinction  between  the  two  cases 
is  simply  that  in  the  actual  one  whatever  the  Committee 
chose  to  say  was  supported  by  the  Prince  of  Wales  and 
various  eminent  doctors,  who,  of  course,  were  wholly 
dependent  for  their  information  upon  what  they  were 
told  to  say.  Thus  a  high-sounding  name,  royal  support 
and  an  official  position  have  enabled  all  the  principles 
of  scientific  publication  to  be  contemptuously  flouted, 
and  a  public  challenge  to  be  ignored — no  one  saying  a 
word.  The  whole  thing  sounds  incredible,  but  the  thing 
has  happened.  It  was  a  most  fortunate  chance  for.  at 
any  rate,  a  few  patients  that  my  Daily  Mail  articles  ap- 
peared just  before  the  I.  C.  R.  F.  report.  Otherwise  the 
editor,  "in  view  of  recent  authoritative  medical  opinion," 
could  scarcely  have  consented  to  their  publication. 

As  for  the  medical  press,  the  report  was  allowed  to 
pass  without  any  writer  pointing  out  the  remarkable  con- 
tradiction between  it  and,  say,  the  verdict  of  the  German 
Cancer  Research  Institute,  or  the  results  of  Dr.  Zanoni, 
which  have,  of  course,  been  noted  in  the  American  med- 
ical press,  but  have  been  ignored  in  this  country. 

It  is  not  for  a  moment  to  be  supposed  that  the  sur- 


34.8  THE  CONQUEST  OF  CANCER 

geons  and  others  who  founded  the  Imperial  Cancer  Re- 
search Fund  are  responsible  for  the  facts  above  recorded. 
Their  enterprise  was  a  wise  and  right  and  promising  one, 
and  the  utmost  honor  is  due  to  the  surgeons,  and 
especially  to  the  most  distinguished  of  their  number,  for 
their  efforts  to  have  the  problems  of  cancer  attacked 
afresh  from  the  scientific  side,  the  clinical  attack  having 
so  appallingly  failed.  I  only  wish  I  were  at  liberty  to 
mention  the  name  of  the  world-famous  surgeon  and  au- 
thority upon  cancer  to  whom  the  Fund  owes  so  much, 
and  who,  proving  his  open-mindedness,  caused  a  letter 
to  be  sent  to  Dr.  Beard,  September  5,  1907,  within  a  few 
days  after  the  appearance  of  my  article  in  the  Contem- 
porary Reviczv,  in  which  a  request  was  made  for  direc- 
tions as  to  the  use  of  the  ferments  in  a  case  which  the 
writer  and  this  surgeon  ''are  anxious  to  treat  exactly 
according  to  your  method" — the  method  which,  only  a 
month  or  two  before,  had  been  publicly  condemned  by 
the  Fund  in  the  history  of  which  this  surgeon  has  played 
an  indispensable  part.  Thus  there  are  now  two  surgeons 
in  Great  Britain  whom  I  should  be  honored  to  name  here, 
and  I  deeply  regret  that  I  am  not  permitted  to  do  so  in  the 
one  case,  and  do  not  know  the  name  in  the  other, 

I  need  now  deal  only  very  briefly  with  the  Middlesex 
Hospital  Report  {Archives  of  the  Middlesex  Hospital, 
vol.  ix.,  Sixth  Report  from  the  Cancer  Research  Labora- 
tories). This  inquiry  was  undertaken  at  my  demand  in 
the  Pall  Mall  Gazette  last  December.  Dr.  Beard's  gen- 
eral directions  were  asked  for  and  sent;  but  neither  he 
nor  I  was  consulted  or  informed  in  any  way  further. 
The  inquiry  was  confided  to  two  extremely  youthful  and 
inexperienced  observers.  The  patients  were  obviously 
hopeless,  if  not  moribund.     Certain  of  the  requirements 


THE  POWERS  THAT  BE  349 

made  by  me  in  the  Pall  Mall  Gazette  were  attended  to, 
such  as  the  testing  of  the  injections  and  the  avoidance 
of  heating  the  syringe.     When  we  come  to  examine  the 
report   we   find   the  most    astonishing    omissions.     The 
surgical  history  of  none  of  the  cases  is  given;  there  is 
absolutely  no  record  of  the  urine  in  any  case,  not  even 
as  to  the  presence  of  albumin,  much  less  the  excretion 
of  trypsin.     There  is  not  a  word  about  the  blood,  so  that 
we  have  no  information  as  to  leucocytosis  or  eosinophilia, 
still  less  the  presence  of  trypsin  in  it.     Thus  we  are  en- 
tirely without  evidence,  which  would  have  been   quite 
easy  to  obtain,   that  trypsin  ever  entered  the  patients' 
blood.     In  these  and  all  other  points,  from  the  qualifica- 
tions of  the  observers  onwards,  we  may   contrast  this 
inquiry  with  those  in  Berlin.     Most  of  the  patients  re- 
ceived no  adequate  doses.     The  injections  were  so  made 
that  they  caused  great  pain  and  discomfort   ("this  has 
always  been  the  determining  factor  in  causing  the  patient 
to  plead  for  a  discontinuance  of  the  treatment"),  and  we 
are  warned  as  to  the  "occasional  production  of  inflamma- 
tion or  even  suppuration."     As  the  editorial  writer  of  the 
General  Practitioner  has  pointed  out,  this  alone  would 
entitle  us  to  disregard  the  report,  and,  in  the  absence  of 
any  inquiry  by  modern  clinical  methods,  we  may  probably 
agree  with  a  correspondent  of  that  journal  who  questions 
whether  active  trypsin  ever  entered  the  patients'  blood. 
These  brief  comments  may  be  concluded  by  the  quotation 
of  an  early  paragraph :     "Two  cases  of  carcinoma  were 
placed  on  trypsin  treatment  in  May,  1906,  in  the  cancer- 
wards  of  the  Middlesex  Hospital,  but  with  negative  re- 
sult, there  being  no  improvement  in  the  patients,  nor  was 
the  progress   of  the  growth  influenced  by  the  trypsin 
injections."     On  turning  over  the  page  the  reader  will 


350  .THE  CONQUEST  OF  CANCER 

find,  to  his  amazement,  that  the  second  of  these  patients 
had  only  one  injection,  and  that  of  a  2  per  cent,  solution 
so  called.  If  this  fact  does  not  serve  to  indicate  the 
observers'  bias,  nothing  will.  A  few  favorable  results 
were  observed,  such  as  diminution  of  pain  in  one  case, 
the  disappearance  of  obstruction  in  the  rectum  in  another, 
a  stationary  condition  in  a  third,  and  certain  microscopic 
features  in  two  others ;  but  the  observers  attach  no  im- 
portance to  them,  nor  do  I,  though  they  may  possibly 
indicate  that  the  local  disasters  which  followed  the  in- 
jections may  not  have  involved  the  entire  destruction  of 
the  ferments.  One  case  underwent  enormous  loss  of 
weight  "during  the  special  treatment,  whereas  he  had  re- 
mained in  a  fairly  stationary  condition  previous  to  the 
commencement''  of  it.  This  alone  would  suffice  to  indi- 
cate the  fashion  in  which  the  treatment  was  carried  out. 

The  observers  conclude',  and  the  conclusion  is  con- 
curred in  by  the  distinguished  surgeon  who  was  in  charge 
of  the  patients,  as  by  the  director  of  the  laboratories, 
that  "the  course  of  cancer,  considered  both  as  a  disease 
and  as  a  morbid  process,  is  unaltered  by  the  administra- 
tion of  trypsin  and  amylopsin." 

Such  is  the  scientific  and  clinical  quality  of  the  report 
which  was  hailed  with  joy  as  conclusive  by  the  British 
Medical  Journal  and  elsewhere,  while  the  diametrically 
opposite  result  already  published  by  Prof.  Von  Leyden 
and  Dr.  Bergell  was  absolutely  ignored.  I  specially  re- 
gret that  we  have  no  information  as  to  the  urine.  Obvious 
considerations  would  have  prevented  me  from  making 
this  demand  along  with  the  others  in  the  Pall  Mall  ■ 
Gazette,  even  had  it  occurred  to  me  for  a  moment  that 
this  most  elementary  of  all  observations  would  have  been 
ignored. 


CHAPTER  XXI 

CONCLUSION 

"Wheresoever  the  carcass  is,  there  will  the  eagles  be 
gathered  together,"  and  wheresoever  cancer  is,  there  will 
liars  and  thieves  be  gathered  together,  unless  they  are 
driven  off.  Less  merciful  than  the  birds  of  prey,  these 
beasts  of  prey  do  not  wait  until  life  has  fled,  but  prey 
upon  the  living.  Not  once  but  many  times  I  have  used 
such  opportunities  as  have  been  mine  to  warn  the  public 
against  the  cruel  and  murderous  blackguards,  with  their 
nostrums  and  lies,  who  prey  upon  those  whom  cancer 
has  already  marked  down  for  them.  Such  are  the  facts 
of  experience  that  any  one  who  proclaims  a  remedy  for 
cancer  is  suspect  of  being  a  quack.  In  this  very  instance 
it  is  the  case  that  practically  all  the  "help"  I  have  received 
during  the  past  eighteen  months  has  been  the  worthless 
and  self-interested  "help"  of  a  few  quacks,  nearly  all  of 
them  qualified  quacks — in  whom  every  organized  pro- 
fession on  earth  abounds — who  have  raised  their  voices 
to  swell  their  pockets.  It  is  necessary,  then,  briefly  to 
observe  that  Dr.  Beard  is  not  a  medical  man  but  an 
embryologist,  and  that  I  do  not  practice  medicine.  Dr. 
Beard  may  not  care  that  I  should  speak  of  his  tireless 
labors,  his  enormous  correspondence,  his  prompt  and  ex- 
haustive advice,  refused  to  none,  and  all  this  and  much- 
more  for  love  alone.  I  will  insert  against  his  wishes  the 
fact  that  he  has  gladly  defrayed  the  cost  of  treating  poor 

351 


352     THE  CONQUEST  OF  CANCER 

patients  by  his  method.  As  for  myself,  though  I  have 
seen  many  patients  and  watched  tliem  from  day  to  day, 
I  have  taken  nothing  from  any  one — on  the  contrary. 
IVIy  own  Hne  of  work  has  been  gravely  interrupted,  with 
serious  effects  of  more  than  one  kind ;  and  if  the  reader 
were  fully  acquainted  with  the  details  of  my  days  since 
Januar}-,  1906,  he  would  understand  how  it  is  that  I  per- 
mit myself  to  express  with  simple  candor  my  opinion  of 
the  writings  of  medical  journalists  and  others  who  have 
never  seen  a  trypsin  injection  in  their  lives,  and  know  no 
•more  of  the  subject  than  I  do  of  Sanscrit;  persons  who 
have  made  no  sacrifices  of  any  kind,  whether  of  time,  or 
thouglit,  or  money,  have  run  no  risks  of  the  loss  of  per- 
sonal reputation,  but  have  not  hesitated,  in  their  brave 
anonymity,  to  demand  apologies,  to  suppress  facts,  to 
misquote,  to  make  every  conceivable  misrepresentation, 
and  in  effect  to  deprive  tens  of  thousands  of  cancer- 
patients,  already  beyond  all  hope  of  surgery  or  other 
means,  of  the  practical  certainty  of  relief  from  pain  and 
foetor,  and  the  promise  of  much  more,  which  the  new 
treatment  would  have  afforded  them.  It  matters  little 
to  me  now  that  this  anonymous  and  motley  crowd  should 
have  made  personal  attacks  upon  myself:  it  certainly 
matters  nothing  to  Dr.  Beard  that  they  should  have 
spilt  their  venom  on  him :  "there  are  some  praises  which 
reproach,  and  some  reproaches  which  praise,"  as  La 
Rochefoucauld  said :  but  it  does  matter  that  any  opposi- 
tion to  a  useful  remedy  for  cancer  should  have  been  suc- 
cessful even  for  a  day,  or  even  in  one  single  case — let 
alone  for  nearly  two  years  and  in  tens  of  thousands  of 
cases.     There  is  blood  upon  many  hands. 

I  foresee  that  some  critics,  partly  out  of  malice  and 
partly  in  self-defense,  will  accuse  me  of  having  been  "pre- 


CONCLUSION  353 

mature"  in  my  writings.  But  how  otherwise  could  the 
subject  have  passed  the  stage  at  which  discussion  was 
"premature"?  The  customary  channels  were  closed. 
There  was,  indeed,  much  premature  writing  and  speak- 
ing on  the  subject.  Perhaps  the  Director  of  the  Imperial 
Cancer  Research  Fund  was  premature  in  stating  at 
Montreal,  in  July,  1906,  that  trypsin  had  been  tested  and 
was  worthless — a  curious  way  of  stating  the  fact  that  if 
he  had  tested  his  trypsin  he  would  have  found  it  worth- 
less. The  truth  is  that,  as  human  nature  is  constituted, 
the  new  thing  always  appears  premature  to  the  majority; 
this  really  means,  not  that  it  is  premature,  but  that  they 
are  immature.  If  the  profession  and  the  public  had 
known  a  few  elementary  facts  about  ferments  two  years 
ago  my  writings  would  not  have  been  premature  simply 
because  my  readers  would  have  been  prepared  for  them. 
I  was  blamed  because  they  were  ignorant ;  as  I  was  until 
I  looked  into  the  matter.  But  there  was  no  possible 
means  of  removing  the  ignorance  except  by  drawing 
attention  to  the  subject. 

I  hope  that  this  case  has  a  real  sociological  meaning. 
I  hope  it  means  that  the  press  will  furnish  the  true  and 
efficient  means  of  protection  against  the  increasing 
officialism  of  all  activities,  including  even  scientific 
thought,  in  our  day.  Officialism  there  must  be,  and  Re- 
search Committees  and  so  forth:  but  not  until  I  hear 
that  Shakespeare  was  a  syndicate,  that  gravitation  was 
discovered  by  a  committee,  that  Tristan  und  Isolde, 
which  was  created,  music  and  verse,  by  one  mind,  is 
inferior  to  the  latest  musical  comedy,  whose  composers 
and  authors  would  sink  a  barge  well  lost — in  short,  not 
until  I  cease  to  be  convinced  that  nothing  but  personality 
ever  did  anything  worth  doing,  shall  I  cease  to  protest 


354     THE  CONQUEST  OF  CANCER 

that,  however  splendid  otir  apparatus  for  research,  or  our 
schools  of  art,  or  our  established  creeds,  there  will  arise 
some  day  a  man,  within  or  without  the  official  barriers, 
and  will  flick  them  away  like  a  crumb  from  a  cloth.  If 
the  race  ceases  to  produce  the  ori,c:inal  man,  its  progress 
will  cease.  We  need  not  be  deluded :  half  a  dozen  dwarfs 
may  outweigh  one  giant,  but  the  analogy  of  mass  has  no 
application  in  the  spiritual  world.  The  united  labors 
of  all  men  now  living  could  not  write  another  Tristan: 
and  though  from  one  mediocrity  you  may  obtain,  by  a 
rare  inspiration,  something  good,  from  a  committee  of 
mediocrities  you  will  certainly  never  obtain  anything  but 
a  mediocre  result;  if  one  of  them  does  have  an  inspired 
moment,  the  rest  will  see  that  no  harm  comes  of  it.  We 
foolishly  repeat  that  two  heads  are  better  than  one:  but 
it  depends  on  the  heads.  Plow  many  Donizettis  would 
it  take  to  write  one  Choral  Sym phony F  Not  only  does 
one  wise  man's  verdict  outweigh  all  the  fools',  as  Brown- 
ing said ;  but  in  two  seconds  he  may  add  more  to  the 
eternal  wealth  of  mankind  than  they  in  all  their  lives,  be 
they  never  so  endowed  with  money,  and  opportunity,  and 
authority.  The  world  is  governed,  said  Goethe,  by  wis- 
dom, by  authority,  and  by  show.  When  a  great  medical 
journal  propounds  ignorant  and  inexcusable  misrepre- 
sentations of  a  new  truth  which  has  not  come  through 
the  only  mechanism  that  excuses  a  truth  for  being  new, 
or  when  a  great  research  institute  pronounces  without 
any  knowledge  upon  the  work  of  some  one  whose  claim 
to  be  heard  is  merely  the  idle  one  that  he  is  a  sincere  and 
assiduous  lover  of  truth — then  the  world  is  governed  by 
authority  and  by  show.  It  is  time  that,  in  these  days  of 
organized  research  and  social  mechanism  in  general,  we 
should  remind  ourselves  of  the  known  facts  of  the  genesis 


CONCLUSION  355 

of  all  discovery  and  all  new  creation,  whether  in  science, 
or  art,  or  any  other  sphere.  I  have  lately^  discussed  this 
subject,  but  I  cannot  neglect  the  opportunity  of  pointing 
the  moral  here. 

Let  us  take  a  lesson  to  ourselves.  "History  warns 
us,"  says  Huxley,  ''that  it  is  the  customary  fate  of  new 
truths  to  begin  as  heresies  and  to  end  as  superstitions." 
This  is  one  of  that  small  band  of  epigrams  which  are 
at  once  profound  and  true.  Now  the  doctrine  that  there 
is  no  remedy  for  cancer  but  the  knife  was  at  one  time  a 
heresy,  and  arose  when  the  science  of  diagnosis  had  so 
advanced  that  curable  maladies,  formerly  thought  to  be 
cancerous,  were  properly  identified.  This  new  truth  was 
until  lately  true;  but  it  had  the  "customary  fate,"  and 
ended,  or  is  ending,  as  a  maleficent  superstition.  The 
newer  truth  that  certain  ferments  are  remedial  in  cancer 
began  as  a  heresy,  in  opposition  to  the  orthodox  view 
that  the  knife  alone  is  a  remedy  for  cancer.  This  new 
truth  will  shortly  begin  to  take  its  place  as  an  orthodox 
dogma.  But  let  us  beware.  At  any  moment  in  the  im- 
mediate or  the  remoter  future,  when  the  value  of  the  pan- 
creatic or  other  known  ferments  is  a  commonplace,  when, 
perhaps,  men  and  institutions  exist  to  demonstrate  it,  or 
great  chemical  laboratories  to  prepare,  or  even  manufac- 
ture, these  ferments — in  a  word,  when  vested  interests 
are  involved,  as  the  Church  is  involved  in  its  dogmas,  or ' 
the  proprietor  of  anything  in  our  conventional  beliefs 
regarding  property — there  may  arise  a  new  heresy.  Some 
one  may  discover  a  new  ferment  which  does  in  hours 
what  trypsin  does  in  weeks  or  months,  some  one  may 
discover  hozv  to  prevent  the  occurrence  of  cancer — and 

^In  two  lectures  on  "Biology  and  Progress,"  delivered  at  the 
Royal  Institution,  March,  1907. 


356  ,THE  CONQUEST  OF  CANCER 

how  shall  we  behave?  If  we  are  not  to  learn  from  the 
past — and  each  generation  makes  this  same  mistake,  in 
art,  and  science,  and  religion,  and  politics,  and  every- 
thing else,  while  deriding  its  predecessors  for  the  very 
same  act — we  shall  lie  and  malign,  and  suppress,  and 
misrepresent,  and  obstruct,  and  deny.  As  the  first  dis- 
ciple of  Dr.  Beard,  I  myself,  if  I  live  to  see  such  a  day, 
as  I  very  probably  shall — I  myself  will  be  the  foremost 
to  declare  that  nothing  can  possibly  be  better  than  trypsin 
and  amylopsin,  or  half  so  good;  that  the  innovators  are 
irresponsible,  and  ignorant,  and  dishonest ;  that  the  estab- 
lished truths  which  have  done  such  service  are  in  danger 
at  the  hands  of  those  to  whom  all  truth  is  an  offense,  that 
the  heretic  has  no  official  status,  has  not  received  the 
license  of  the  "Trypsin  Institute,"  let  us  say,  and  that,  as 
will  likely  enough  be  true,  he  is  "not  even  a  medical  man." 
Only  do  I  hope  that  if  and  when  this  event  happens,  some 
one  will  quote  these  present  words  and  put  me  abruptly 
to  silence. 

So  much  for  this  great  sociological  issue,  and  now  for 
another,  which  is  psychological  and  of  no  less  importance 
in  the  progress  of  knowledge.  It  is  commonly  asserted 
that  the  foundation  and  root  of  all  science  is  skepticism, 
the  spirit  which  questions  and  will  not  believe  until  it 
must :  I  have  often  discussed  the  importance  of  this  atti- 
tude. The  performance  of  this  function  is  the  chief  and 
only  use  of  what  we  may  call  the  inferior  class  of  scien- 
tific minds.  These  play  the  part  of  heredity  as  opposed 
to  variation  in  the  realm  of  organic  evolution,  and  of 
conservatism  as  opposed  to  liberalism  in  the  State.  But 
it  would  be  a  ludicrous  denial  of  the  major  facts  in  the 
history  of  knowledge  to  suppose  that  the  opposite  state 
of  mind,  that  of  faith,  has  no  place  therein.     It  would  be 


CONCLUSION  357 

easy  to  demonstrate,  but  surely  superfluous,  that  the  great 
achievements  in  science  have  one  and  all  been  made  by 
men  who  believed  in  some  idea  before  the  acquirement 
of  conclusive  evidence  in  its  favor.  It  was  this  faith 
which  inspired  them  to  seek  and  reveal  the  evidence 
which  ultimately  established  their  case :  and  only  by  such 
faith  can  the  mountains  of  prejudice  be  moved.  The 
sober  onlooker  talks  of  infatuation  or  monomania,  and 
duly  performs  the  skeptical  function,  which  is  so  easy 
and  so  safe.  All  great  enterprises  appear  insane  to  the 
onlooker  at  first.  But  the  believer  goes  on  and  on,  turn- 
ing neither  to  the  right  hand  nor  to  the  left.  Often 
enough  he  is  wrong,  whereupon  the  skeptics,  who  are 
always  in  the  majority,  congratulate  each  other  upon 
their  superior  acumen.  But  sometimes  he  is  right:  and 
then,  and  then  only,  and  never  otherwise,  science  moves 
on. 

Consider  the  case  in  point.  A  host  of  practitioners, 
disbelieving,  have  tried  the  new  remedies  and  obtained 
nothing  but  failure.  The  disbeliever,  since  he  disbelieves, 
attributes  his  failure  to  the  nature  of  the  case:  and  tlie 
matter  is  closed  for  him.  But  the  believer,  since  he  be- 
lieves, attributes  his  failure  to  himself.  According  to 
his  faith,  such  and  such  a  result  should  have  been  ob- 
tained. Since  it  was  not  obtained,  it  is  plain  that  he  has 
gone  wrong  somewhere.  He  looks  for  sources  of  error 
— such  as  the  use  of  inert  injections — removes  them,  and, 
if  his  faith  is  well-founded,  he  succeeds.  Observe  the 
function  of  the  psychological  state  called  faith  in  this 
respect.  How  innumerable  are  the  instances  which  might 
be  adduced.  A  Newton  conceives  a  law  of  universal 
gravitation,  and,  since  he  is  a  Newton,  this  law  inspires 
him  with  faith  in  its  truth.     He  has  practically  no  evi- 


858     THE  CONQUEST  OF  CANCER 

dence :  just  as  Dr.  Beard  had  absolutely  no  experimental 
evidence  whatever  when  he  announced  that  trypsin  must 
be  remedial  in  cancer.  He  sets  to  work  to  make  the 
necessary  calculations  from  the  data  of  a  Kepler,  in  order 
to  prove  the  truth  of  his  theory — which,  like  all  theories 
and  truths  in  the  first  instance,  is  his  own  peculiar  and 
unshared  possession.  The  calculations  are  made  and  do 
not  tally  with  the  theory.  Any  one  else,  having  made 
them  and  found  them  discrepant,  would  contentedly  drpp 
the  whole  matter.  But  the  Newton,  since  he  has  faith, 
returns  to  his  laborious  task,  finds  an  accidental  error  in 
reckoning-,  and  produces  a  new  series  of  calculations 
which  prove  his  faith  to  be  founded  on  the  rock  of  fact 
— and  all  future  ages  are  enriched  with  a  new  truth,  the 
only  kind  of  wealth  which  neither  moth  nor  rust  c?in 
corrupt,  and  which  can  be  used  and  spent  and  remain 
inexhaustible,  the  treasury  of  true  ideas  being  the  fact 
of  which  the  inexhaustible  purse  of  Fortunatus  was  a 
symbol.  Now  it  is  right  to  doubt  when  evidence  is  inade- 
quate, or  rather,  it  is  right  for  all  men  but  one  to  doubt: 
but  it  is  also  well  that  one  man,  he  who  conceived  the 
new  thing,  should  believe,  evidence  or  no  evidence.  Let 
the  others  boast  their  "scientific  caution,"  which  is  more 
often  than  not  only  cowardice,  or  ignorance,  or  lack  of 
imagination,  or  desire  to  be  left  alone,  the  analogue  of 
inertia  in  the  physical  world :  but  when  there  fails  a  sup- 
ply of  men  who  see,  though  only  in  a  vision,  a  goal  which 
to  all  others  is  a  delusion,  and  who  press  towards  it 
though  all  others  declare  that  to  leave  the  beaten  track  is 
to  land  in  shallows  and  miseries — then  all  progress  in  all 
spiritual  spheres,  art  or  religion  or  science,  will  cease, 
and  the  sooner  the  sun  grows  cold  the  better — unless,  as 
Professor  Lowell  declares  against  the  critics  who  have 


CONCLUSION  859 

not    his    opportunities,    there  be    intelHgent    hfe   upon 
Mars. 

Let  me  endeavor  to  make  good  a  further  point  with 
the  aid  of  the  mighty  German  I  have  just  quoted.  Goethe 
somewhere  says,  "We  learn  to  knozv  nothing  but  zvhat 
zve  love;  and  the  deeper  we  mean  to  penetrate  into  any 
matter  with  insight,  the  stronger  and  more  vital  must  our 
love  and  passion  be."  This  is  one  of  the  most  profound 
and  universally  significant  of  psychological  truths,  and 
has  yet  to  be  recognized  by  those  who  commonly  write 
as  if  knowledge  and  intellectual  activity  were  entirely  un- 
related to  the  emotional  nature.  The  common  view  sur- 
vives from  the  disproved  "faculty"  psychology.  But  all 
the  history  of  the  deeds  of  mind  proves  the  truth  of 
Goethe's  words.  When  the  conception  of  universal  grav- 
itation came  to  Newton,  he  was  not  thinking  how  to  earn 
the  absurd  knighthood  of  his  later  years,  nor  of  how 
many  guineas  per  thousand  words  he  could  obtain  for 
writing  on  the  subject,  nor  how  to  score  a  point  against 
a  colleague.  He  was  deeply  in  love  with  the  subject, 
and  his  love  led  him  to  the  truth.  It  is  so  with  the  crea- 
tion of  every  great  work  of  art.  The  writer  who  asks 
"Will  it  sell?"  as  he  writes,  will  never  write  anything 
fit  to  sell:  the  dramatist  who  asks  "Will  it  draw?"  will 
never  write  a  play  fit  to  draw  any  but  moths  and  their 
like.  Nothing  supremely  great,  nothing  too  hard  for  the 
teeth  of  time,  was  ever  achieved  except  for  the  love  of  it. 
The  universal  goddess  who  is  the  mother  of  all  past 
achievement  and  whose  fertility  is  not  yet  exhausted, 
being  inexhaustible,  has  but  one  question  which  she  asks 
of  all  who  woo  her — poet,  painter,  pathologist,  and  all 
others.  "Do  you  love  me  for  myself  alone?"  she  asks. 
The  maiden  asks  the  same  wise  question,  but  she  may  be 


360     THE  CONQUEST  OF  CANCER 

deceived.  Nature,  however,  is  not  mocked.  The  wooer 
who  is  after  her  money,  or  position,  or  the  chance  of 
spiting  some  one  else,  cannot  cozen  her,  protest  he  never 
so  loudly  that  his  heart  is  hers  alone.  But  she  will  admit 
to  her  embraces  all  who  do  indeed  love  her ;  and  never  to 
such  will  the  joy  of  fatherhood  be  denied.  The  fruit  of 
their  love  may  be  a  lyric  or  an  epic,  a  single  fact  of  ob- 
servation or  a  universal  truth,  but  fruit,  and  sound  fruit, 
there  will  always  be.  The  stronger  and  more  vital  the 
lover's  passion  the  worthier  will  be  its  product. 

Such,  in  image,  is  the  parental  history  of  all  the  chil- 
dren of  men's  minds  and  souls :  and  we  must  beware  lest 
we  forget  it.  "We  learn  to  know  nothing  but  what  we 
love" :  and  without  lovers  of  knowledge  or  beauty  for 
their  own  sake,  nothing  worthy,  nothing  viable,  will  ever 
come  to  birth,  though  the  whole  earth  were  covered  with 
one  huge  laboratory  or  one  huge  school  of  art. 

We  all  agree  that  it  is  the  emotional  nature  which 
makes  the  artist.  Music  is  not  mere  applied  mathemati- 
cal acoustics,  nor  poetry  applied  philology.  The  composer 
or  the  poet,  the  artist  of  any  order,  must  have  the  soul  of 
an  artist,  a  heart  that  beats  in  time  with  the  music  of  the 
spheres  and  the  tones  of  human  life.  We  usually  sup- 
pose, however,  that  in  science  and  philosophy  the  emo- 
tional requirement  is  nil,  that  intellect  is  everything,  and 
that,  indeed,  any  kind  of  emotion  is  a  hindrance  and  a 
defect.  This  common  doctrine  wholly  ignores  the 
psychology  of  knowledge,  as  Goethe  has  indicated  it  for 
us.  Only  the  man  who  is  driven  by  the  motor-power  of 
disinterested  interest,  or  love,  only  the  man  who  lives  for 
love  of  his  subject,  and  who  would  find  life  worthless 
without  this  love — only  he  will  reach  the  goal. 

Science  now  offers  a  career  to  thousands,  where  for- 


CONCLUSION  361 

merly  it  was  followed  only  by  the  inwardly  directed  or 
predestined  few.  But  we  must  be  warned  in  time. 
Nature  will  have  no  father  for  her  spiritual  children  but 
those  who  love  her  for  herself  alone,  and  she  cannot  be 
deceived.  Study  the  biographies  of  the  "kings  of 
thought,"  "the  splendors  of  the  firmament  of  time,"  as 
Shelley  calls  them,  and  see  how  broadly  it  is  written 
that  each  of  them  might  truly  have  described  himself  to 
nature  as  "One  born  to  love  you,  sweet!"  To  such  a 
one  his  love  is  his  "whole  existence":  it  is  not  immune 
from  error,  but  it  is  never  sterile.  Only  of  such  disin- 
terested and  whole-hearted  love  is  knowledge  born,  the 
knowledge  so  born  has  brought  mankind  thus  far,  and, 
unless  the  supply  of  true  lovers  fails,  or  men  imprison 
or  emasculate  them,  future  knowledge  so  born  will  yet 
transmute  the  conditions  of  life  and  even  human  nature 
itself,  not  without  the  pains  and  groans  of  travail,  which 
shall  burst  into  sphere  music  before  the  earth's  race  be 
run. 

The  sun  is  always  rising  somewhere  upon  the  sphere 
of  the  mind ;  there  are  men  who  love  the  past,  the  sunset ; 
men  who  glory  in  the  sure  and  strong  thing,  the  sun  at 
noon;  but  the  prayer  for  him  who  believes  that  the  best 
is  yet  to  be,  and  who  would  rather  hail  a  false  dawn  for 
a  time  than  deny  a  true  one,  is  this :  Let  neither  old  age, 
nor  habit,  nor  love  of  self  or  ease,  nor  any  other  thing, 
be  permitted  to  obscure  the  eastward  windows  of  my  soul. 


